Provider Demographics
NPI:1164756714
Name:CHERRY HOSPITAL STATE OF NORTH CAROLINA
Entity Type:Organization
Organization Name:CHERRY HOSPITAL STATE OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:1401 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1078
Mailing Address - Country:US
Mailing Address - Phone:919-731-3204
Mailing Address - Fax:919-731-3785
Practice Address - Street 1:1401 W ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530
Practice Address - Country:US
Practice Address - Phone:919-731-3204
Practice Address - Fax:919-731-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404026Medicaid
NC344026Medicare Oscar/Certification