Provider Demographics
NPI:1073634879
Name:FRYE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:FRYE REGIONAL MEDICAL CENTER
Other - Org Name:OAKWOOD PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCRARRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, CCS
Authorized Official - Phone:828-327-4156
Mailing Address - Street 1:2850 TATE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1450
Mailing Address - Country:US
Mailing Address - Phone:828-327-4156
Mailing Address - Fax:828-327-7158
Practice Address - Street 1:2850 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1450
Practice Address - Country:US
Practice Address - Phone:828-327-4156
Practice Address - Fax:828-327-7158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-018-039276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid