Provider Demographics
NPI:1073699492
Name:SMOKY MOUNTAIN CENTER FOR MH/DD/SAS
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN CENTER FOR MH/DD/SAS
Other - Org Name:BALSAM CENTER FOR HOPE AND RECOVERY
Other - Org Type:Other Name
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCDEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-454-1098
Mailing Address - Street 1:44 BONNIE LANE
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8511
Mailing Address - Country:US
Mailing Address - Phone:828-586-5501
Mailing Address - Fax:828-586-3965
Practice Address - Street 1:91 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786
Practice Address - Country:US
Practice Address - Phone:828-454-1098
Practice Address - Fax:828-454-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 044 039273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300801Medicaid
NC6005662Medicaid
NC2801105Medicare ID - Type Unspecified