1669638821 NPI number — APPALACHIAN COUNSELING OUTPATIENT

Table of content: (NPI 1669638821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669638821 NPI number — APPALACHIAN COUNSELING OUTPATIENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN COUNSELING OUTPATIENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAPESTRY RESIDENTIAL EATING DISORDER PROGRAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669638821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 TUNNEL RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28805-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-350-1000
Provider Business Mailing Address Fax Number:
828-350-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 N COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-8908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-884-2475
Provider Business Practice Location Address Fax Number:
828-884-2187
Provider Enumeration Date:
08/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUSTED
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
770-639-9657

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  MHL-045-121 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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