Provider Demographics
NPI:1952439648
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 1:100 THOMAS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-9799
Mailing Address - Country:US
Mailing Address - Phone:828-524-4435
Mailing Address - Fax:
Practice Address - Street 1:100 THOMAS HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-9799
Practice Address - Country:US
Practice Address - Phone:828-524-4435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901891Medicaid
NC2801105Medicare ID - Type Unspecified