Provider Demographics
NPI:1629322292
Name:SOUTH EAST MECKLENBURG COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:SOUTH EAST MECKLENBURG COUNTY HEALTH DEPARTMENT
Other - Org Name:MECKLINK BEHAVIORAL HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ENDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-336-8638
Mailing Address - Street 1:429 BILLINGSLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1089
Mailing Address - Country:US
Mailing Address - Phone:704-336-6404
Mailing Address - Fax:
Practice Address - Street 1:429 BILLINGSLEY ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1089
Practice Address - Country:US
Practice Address - Phone:704-336-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization