Provider Demographics
NPI:1790800225
Name:SMOKY MOUNTAIN CENTER FOR MH DD SAS
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN CENTER FOR MH DD SAS
Other - Org Name:SMOKY MOUNTAIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCDEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-5501
Mailing Address - Street 1:44 BONNIE LANE
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8511
Mailing Address - Country:US
Mailing Address - Phone:828-586-5501
Mailing Address - Fax:828-586-3965
Practice Address - Street 1:91 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-7927
Practice Address - Country:US
Practice Address - Phone:828-586-5501
Practice Address - Fax:828-586-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2801105DOtherMEDICARE
NC6005662Medicaid
NC2801105Medicare ID - Type Unspecified