Provider Demographics
NPI:1609477538
Name:COPESTONE PSYCHIATRIC, LLC
Entity Type:Organization
Organization Name:COPESTONE PSYCHIATRIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-393-9025
Mailing Address - Street 1:224 THOMPSON ST
Mailing Address - Street 2:PMB 218
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2806
Mailing Address - Country:US
Mailing Address - Phone:828-393-9025
Mailing Address - Fax:
Practice Address - Street 1:11335 NE 122ND WAY STE 105
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6933
Practice Address - Country:US
Practice Address - Phone:828-393-9025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty