Provider Demographics
NPI:1609833201
Name:CAROLINAEAST MEDICAL CENTER
Entity Type:Organization
Organization Name:CAROLINAEAST MEDICAL CENTER
Other - Org Name:CROSSROADS MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-8880
Mailing Address - Street 1:2000 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-3449
Mailing Address - Country:US
Mailing Address - Phone:252-633-8640
Mailing Address - Fax:252-636-5376
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8640
Practice Address - Fax:252-636-5376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAEAST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-27
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0201273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400131SMedicaid
NC00133OtherNC BLUE CROSS
NC00133OtherNC BLUE CROSS
NC3400131SMedicaid