Provider Demographics
NPI:1841497567
Name:TAR HEEL HUMAN SERVICES-MENTAL HEALTH DIVISION
Entity type:Organization
Organization Name:TAR HEEL HUMAN SERVICES-MENTAL HEALTH DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:910-298-6207
Mailing Address - Street 1:191 NORTH NC HWY. 41
Mailing Address - Street 2:PO BOX 1321
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518
Mailing Address - Country:US
Mailing Address - Phone:910-298-6207
Mailing Address - Fax:910-298-6293
Practice Address - Street 1:191 NORTH NC HWY. 41
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:910-298-6207
Practice Address - Fax:910-298-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904708Medicaid