Provider Demographics
NPI:1457537482
Name:HENDERSONVILLE FAMILY HEALTH CENTER-PSYCH
Entity Type:Organization
Organization Name:HENDERSONVILLE FAMILY HEALTH CENTER-PSYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-696-1000
Mailing Address - Street 1:PO BOX 63314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3314
Mailing Address - Country:US
Mailing Address - Phone:828-696-1234
Mailing Address - Fax:
Practice Address - Street 1:709 N JUSTICE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3454
Practice Address - Country:US
Practice Address - Phone:828-696-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDERSON COUNTY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016WKOtherBCBS
NC2351975CMedicare PIN