Provider Demographics
NPI:1568685584
Name:THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.
Entity Type:Organization
Organization Name:THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.
Other - Org Name:PARK VISTA GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-866-3287
Mailing Address - Street 1:1331 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5166
Mailing Address - Country:US
Mailing Address - Phone:919-866-3287
Mailing Address - Fax:
Practice Address - Street 1:38 THOMAS PARK DR
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-5792
Practice Address - Country:US
Practice Address - Phone:828-456-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-044-033320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804202Medicaid