Provider Demographics
NPI:1376681551
Name:ASHEVILLE CHILDREN'S MEDICAL CENTER, PA
Entity Type:Organization
Organization Name:ASHEVILLE CHILDREN'S MEDICAL CENTER, PA
Other - Org Name:MENTAL HEALTH PROVIDER
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-687-8709
Mailing Address - Street 1:7 VANDERBILT PARK DR
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-687-8709
Mailing Address - Fax:828-687-0126
Practice Address - Street 1:7 VANDERBILT PARK DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-687-8709
Practice Address - Fax:828-687-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005891Medicaid