NPIMap

Organization Active NPI

Behavioral Health Center CMC Randolph

  • Adolescent and Children Mental Health Clinic/Center
  • Charlotte, NC
National Provider Identifier
1093995839
Registry record updated Nov 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
H0071 Issued in NC
Legal business name
BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Practice address
330 Billingsley Road
Behavioral Health Center CMC Randolph
Charlotte, NC 28211-5055
Phone
(704) 444-2444
Fax
(704) 444-2464
NPI assigned
Nov 9, 2007
Last updated
Nov 9, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas E. Gettelman, PHD
Title
Assistant Vice President
Phone
(704) 444-2406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X H0071 NC Primary

Addresses

Primary practice location

330 Billingsley Road
Behavioral Health Center CMC Randolph
Charlotte, NC 28211-5055

Mailing address

501 Billingsley Road
Behavioral Health Center CMC Randolph
Charlotte, NC 28211-1009
Phone (704) 358-2710

Other identifiers 1

IdentifierTypeStateIssuer
8300445GMedicaidNC

Other names 1

  • C&A Diagnostic Assessment Other name

National Provider Directory

National Provider Directory
Tax ID family
CMC Randloph69 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194566400000",
    "number": "1093995839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 BILLINGSLEY ROAD",
            "address_2": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-358-2710",
            "fax_number": "704-358-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BILLINGSLEY ROAD",
            "address_2": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282115055",
            "telephone_number": "704-444-2444",
            "fax_number": "704-444-2464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2007-11-09",
        "status": "A",
        "authorized_official_last_name": "GETTELMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "ASSISTANT VICE PRESIDENT",
        "authorized_official_telephone_number": "704-444-2406",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NC",
            "license": "H0071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300445G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "C&A Diagnostic Assessment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.