Provider Demographics
NPI:1538490024
Name:MONARCH
Entity Type:Organization
Organization Name:MONARCH
Other - Org Name:RICHMOND PSR
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-986-1522
Mailing Address - Street 1:350 PEE DEE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4932
Mailing Address - Country:US
Mailing Address - Phone:704-986-1500
Mailing Address - Fax:704-982-5279
Practice Address - Street 1:1385 CAUTHEN DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4843
Practice Address - Country:US
Practice Address - Phone:910-997-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302914SMedicaid