Provider Demographics
NPI:1033428487
Name:BARIUM SPRINGS HOME FOR CHILDREN KULYNYCH COTTAGE
Entity Type:Organization
Organization Name:BARIUM SPRINGS HOME FOR CHILDREN KULYNYCH COTTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-872-4157
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BARIUM SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28010-0001
Mailing Address - Country:US
Mailing Address - Phone:704-872-4157
Mailing Address - Fax:704-924-7683
Practice Address - Street 1:517 BOSTON AVENUE
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-667-5095
Practice Address - Fax:336-927-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNOT YET ASSIGNED322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNOT YET ASSIGNEDMedicaid