Provider Demographics
NPI:1912023706
Name:BARIUM SPRINGS HOME FOR CHILDREN
Entity Type:Organization
Organization Name:BARIUM SPRINGS HOME FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KOPPELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-872-4157
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BARIUM SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28010-0001
Mailing Address - Country:US
Mailing Address - Phone:704-873-1011
Mailing Address - Fax:704-924-7683
Practice Address - Street 1:839 S MAGNOLIA ST
Practice Address - Street 2:SOUTH ELEMENTARY DAY TREATMENT
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2877
Practice Address - Country:US
Practice Address - Phone:704-873-1011
Practice Address - Fax:704-924-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL049090251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301446Medicaid