NPIMap

Organization Active NPI

Behavioral Health Center CMC Randolph

  • Adult Mental Health Clinic/Center
  • Charlotte, NC
National Provider Identifier
1104015023
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
H0071 Issued in NC
Legal business name
BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Practice address
Behavioral Health Center CMC Randolph
501 Billingsley Road
Charlotte, NC 28211-1009
Phone
(704) 444-2539
Fax
(704) 444-2539
NPI assigned
Oct 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 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
Adult Mental Health Clinic/Center 261QM0850X H0071 NC Primary

Addresses

Primary practice location

Behavioral Health Center CMC Randolph
501 Billingsley Road
Charlotte, NC 28211-1009

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
8300443BMedicaidNC

Other names 1

  • Community Support Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Ctr for Mental Health69 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1104015023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
            "address_2": "501 BILLINGSLEY ROAD",
            "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": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
            "address_2": "501 BILLINGSLEY ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-444-2539",
            "fax_number": "704-444-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-10-16",
        "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": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "H0071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300443B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Support Services",
            "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 Oct 16, 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.