Provider Demographics
NPI: | 1962548164 |
---|---|
Name: | CENTRAL REGIONAL HOSPITAL |
Entity type: | Organization |
Organization Name: | CENTRAL REGIONAL HOSPITAL |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DIVISION DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KAREN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BURKES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 919-855-4700 |
Mailing Address - Street 1: | 300 VEAZEY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BUTNER |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27509-1626 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-764-7300 |
Mailing Address - Fax: | 919-764-7338 |
Practice Address - Street 1: | 300 VEAZEY DR |
Practice Address - Street 2: | |
Practice Address - City: | BUTNER |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27509 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-764-7300 |
Practice Address - Fax: | 919-764-7338 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-29 |
Last Update Date: | 2024-10-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 283Q00000X | Hospitals | Psychiatric Hospital |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 3404004 | Medicaid | |
NC | 344004 | Medicare Oscar/Certification |