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  7. NPI Record 1801129127

LAKEWOOD
Complete NPI Record 1801129127
Community/Behavioral Health in Belmont, NC

NPI Status: Active since September 18, 2009

Contact Information

302 GREENWOOD PL
BELMONT, NC
ZIP 28012
Phone: (704) 829-4410

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Title or Position
  21. Authorized Official Telephone Number
  22. Healthcare Provider Taxonomy Code 1
  23. Healthcare Provider Primary Taxonomy Switch 1
  24. Healthcare Provider Taxonomy Code 2
  25. Provider License Number 2
  26. Provider License Number State Code 2
  27. Healthcare Provider Primary Taxonomy Switch 2
  28. Healthcare Provider Taxonomy Code 3
  29. Healthcare Provider Primary Taxonomy Switch 3
  30. Other Provider Identifier 1
  31. Other Provider Identifier Type Code 1
  32. Other Provider Identifier State 1
  33. Other Provider Identifier 2
  34. Other Provider Identifier Type Code 2
  35. Other Provider Identifier State 2
  36. Other Provider Identifier Issuer 2
  37. Other Provider Identifier 3
  38. Other Provider Identifier Type Code 3
  39. Other Provider Identifier State 3
  40. Is Organization Subpart
  41. Parent Organization LBN
  42. Parent Organization TIN

Complete NPI Dataset

This page represents the complete record for NPI 1801129127. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1801129127
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: PO BOX 710
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address City Name: BELMONT
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NC
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address Postal Code: 280120710
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider First Line Business Practice Location Address: 302 GREENWOOD PL
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: BELMONT
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NC
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 280122911
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7048294410
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/18/2009
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/30/2017
The date that a record was last updated or changed.
Authorized Official Last Name: CHILDRESS
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SHANNON
The first name of the authorized official.
Authorized Official Title or Position: CHIEF CLINICAL OFFICER
The title or position of the authorized official.
Authorized Official Telephone Number: 7048294410
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 311ZA0620X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 320900000X
Provider License Number 2: MHL-036-058
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: NC
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 251S00000X
Healthcare Provider Primary Taxonomy Switch 3: Y
Other Provider Identifier 1: 7802691
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: NC
Other Provider Identifier 2: 1619310851
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: NC
Other Provider Identifier Issuer 2: STATE FUNDS
Other Provider Identifier 3: 3408854
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: NC
Is Organization Subpart: Y
Parent Organization LBN: HOLY ANGELS INC
Parent Organization TIN: UNAVAIL