Provider Demographics
NPI: | 1629599717 |
---|---|
Name: | CHEROKEE INDIAN HOSPITAL AUTHORITY |
Entity Type: | Organization |
Organization Name: | CHEROKEE INDIAN HOSPITAL AUTHORITY |
Other - Org Name: | CIHA KANVWODIYI RESIDENTIAL TREATMENT |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | REVENUE CYCLE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | REED |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 828-497-9163 |
Mailing Address - Street 1: | PO BOX 63077 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28263-3077 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-497-9163 |
Mailing Address - Fax: | 828-497-1723 |
Practice Address - Street 1: | 2670 CORNSILK BRANCH RD |
Practice Address - Street 2: | |
Practice Address - City: | ROBBINSVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28771-2877 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-346-6000 |
Practice Address - Fax: | 828-346-6001 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CHEROKEE INDIAN HOSPITAL AUTHORITY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-06-29 |
Last Update Date: | 2023-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YA0400X, 101YM0800X, 1041C0700X, 251B00000X, 251S00000X, 261QM0801X, 261QM0850X, 261QM0855X, 261QM1300X, 261QR0405X, 282N00000X, 320800000X, 324500000X | ||
NC | 320800000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 282N00000X | Hospitals | General Acute Care Hospital | ||
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |