Provider Demographics
NPI:1740388347
Name:EDGECOMBE-NASH MENTAL HEALTH CLINIC BEACON CENTER
Entity Type:Organization
Organization Name:EDGECOMBE-NASH MENTAL HEALTH CLINIC BEACON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-937-8141
Mailing Address - Street 1:500 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1417
Mailing Address - Country:US
Mailing Address - Phone:252-937-8141
Mailing Address - Fax:252-443-9574
Practice Address - Street 1:500 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1417
Practice Address - Country:US
Practice Address - Phone:252-937-8141
Practice Address - Fax:252-443-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301065Medicaid
NC3404937EOtherENDORSED PROVIDER NUMBER
NC8301065GMedicaid
NC3404937OtherBASE PROVIDER NUMBER
NC5901411Medicaid
NC0182OtherMEDICARE GROUP NUMBER
NC3408170Medicaid
NC6005570Medicaid
NC5901411Medicaid