Provider Demographics
NPI:1659428043
Name:NEUSE CENTER MHDDSAS
Entity Type:Organization
Organization Name:NEUSE CENTER MHDDSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFORMATION LIAISON
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-639-7720
Mailing Address - Street 1:PO BOX 1636
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28563-1636
Mailing Address - Country:US
Mailing Address - Phone:252-636-1510
Mailing Address - Fax:
Practice Address - Street 1:405 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4930
Practice Address - Country:US
Practice Address - Phone:252-636-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404939Medicaid