NPIMap

Organization Active NPI

Teen Scene Act 3

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Gastonia, NC
National Provider Identifier
1639352826
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-036-182 Issued in NC
Legal business name
TEEN SCENE ACT 3
Practice address
114 B Hollycrest Lane
Gastonia, NC 28056-9008
Phone
(704) 854-4840
NPI assigned
Dec 11, 2007
Last updated
Dec 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Authorized official

Name
Chanda Truesdell
Title
Owner
Phone
(704) 854-4840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-036-182 NC Primary

Addresses

Primary practice location

114 B Hollycrest Lane
Gastonia, NC 28056-9008

Mailing address

708 S Chestnut St
Gastonia, NC 28054-4548
Phone (704) 854-4840

Other identifiers 1

IdentifierTypeStateIssuer
6604134MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
True Behavioral Healthcare Inc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197417600000",
    "number": "1639352826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 S CHESTNUT ST",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544548",
            "telephone_number": "704-854-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 B HOLLYCREST LANE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280569008",
            "telephone_number": "704-854-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEEN SCENE ACT 3",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2007-12-12",
        "status": "A",
        "authorized_official_last_name": "TRUESDELL",
        "authorized_official_first_name": "CHANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-854-4840"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-036-182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604134",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.