The Mental Health Association in North Carolina, Inc.

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL-005-008 Issued in NC

Legal business name

THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.

Doing business as

Willow Place Group Home

Practice address

603 Long St
West Jefferson, NC 28694-8810

Phone

(336) 246-6504

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Cochran

Title

Financial Assistant

Phone

(919) 866-3287

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willow Place Group Home Doing business as

Locations

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962625061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 SUNDAY DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27607",
            "telephone_number": "919-866-3287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 LONG ST",
            "city": "WEST JEFFERSON",
            "state": "NC",
            "postal_code": "286948810",
            "telephone_number": "336-246-6504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COCHRAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "FINANCIAL ASSISTANT",
        "authorized_official_telephone_number": "919-866-3287",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-005-008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804245",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Place Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in West Jefferson, NC
• Providers in West Jefferson, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• 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.