Provider Demographics
NPI:1376673616
Name:MENTAL HEALTH ASSOCIATION IN NC
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION IN NC
Other - Org Name:RAINBOW HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-7094
Mailing Address - Street 1:619 PLANT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4100
Mailing Address - Country:US
Mailing Address - Phone:252-946-7094
Mailing Address - Fax:
Practice Address - Street 1:619 PLANT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4100
Practice Address - Country:US
Practice Address - Phone:252-946-7094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-007-005320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness