Provider Demographics
NPI:1801948674
Name:SIXTH AVENUE PSYCHIATRIC REHABILITATION PARTNERS, INC.
Entity type:Organization
Organization Name:SIXTH AVENUE PSYCHIATRIC REHABILITATION PARTNERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN. SERVICES MGR.
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:DREVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-489-3893
Mailing Address - Street 1:522 KANUGA RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-5226
Mailing Address - Country:US
Mailing Address - Phone:828-697-1581
Mailing Address - Fax:828-697-4492
Practice Address - Street 1:522 KANUGA RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-5226
Practice Address - Country:US
Practice Address - Phone:828-697-1581
Practice Address - Fax:828-697-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 104100000X, 2084P0800X, 251B00000X
NCMHL-045-070251S00000X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9301703Medicaid
NC6006050Medicaid