Provider Demographics
NPI:1073651733
Name:DOROTHEA DIX HOSPITAL
Entity Type:Organization
Organization Name:DOROTHEA DIX HOSPITAL
Other - Org Name:CENTRAL REGIONAL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR -DSOHF
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:LUCKEY
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:JR
Authorized Official - Credentials:FACHE
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:820 S BOYLAN AVE
Mailing Address - Street 2:3601 MAIL SERVICE CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2246
Mailing Address - Country:US
Mailing Address - Phone:919-733-5540
Mailing Address - Fax:919-733-0743
Practice Address - Street 1:820 S BOYLAN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2246
Practice Address - Country:US
Practice Address - Phone:919-733-5540
Practice Address - Fax:919-733-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404001Medicaid
NC344001Medicare ID - Type Unspecified