NPIMap

Organization Active NPI

Behavioral Health Center CMC Randolph

  • Adult Mental Health Clinic/Center
  • Charlotte, NC
National Provider Identifier
1306043658
Registry record updated Aug 22, 2020
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
1216 N Tryon Street
Behavioral Health Center CMC Randolph
Charlotte, NC 28211-1009
Phone
(704) 336-6570
Fax
(704) 336-3623
NPI assigned
Jun 29, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Thomas E. Gettelman, PH.D.
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

1216 N Tryon Street
Behavioral Health Center CMC Randolph
Charlotte, NC 28211-1009

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
8300446BMedicaidNC

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306043658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 BILLINGSLEY RD",
            "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": "1216 N TRYON STREET",
            "address_2": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-336-6570",
            "fax_number": "704-336-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH CENTER CMC RANDOLPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2020-08-22",
        "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": "PH.D."
    },
    "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": "8300446B",
            "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 Aug 22, 2020; 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.