Provider Demographics
NPI:1629366109
Name:CAROLINA BEHAVIORAL CARE
Entity Type:Organization
Organization Name:CAROLINA BEHAVIORAL CARE
Other - Org Name:CAROLINA BEHAVIORAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-493-5250
Mailing Address - Street 1:289 OLMSTED BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8729
Mailing Address - Country:US
Mailing Address - Phone:910-295-6007
Mailing Address - Fax:
Practice Address - Street 1:289 OLMSTED BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8729
Practice Address - Country:US
Practice Address - Phone:910-295-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3459054OtherNCPDP PROVIDER IDENTIFICATION NUMBER