Provider Demographics
NPI:1891839650
Name:CATAWBA COUNTY DSS
Entity Type:Organization
Organization Name:CATAWBA COUNTY DSS
Other - Org Name:CORNER HOUSE I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESIDENTIAL SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QP
Authorized Official - Phone:828-464-6840
Mailing Address - Street 1:1116 RADIO STATION RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9479
Mailing Address - Country:US
Mailing Address - Phone:828-464-6307
Mailing Address - Fax:
Practice Address - Street 1:1116 RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-9479
Practice Address - Country:US
Practice Address - Phone:828-464-6307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL018060322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603263Medicaid