Provider Demographics
NPI:1285962936
Name:MONARCH
Entity type:Organization
Organization Name:MONARCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DWI SPECIALIST 1
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAITY
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:704-986-1550
Mailing Address - Street 1:610 YADKIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 YADKIN STREET
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-986-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONARCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1532302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization