Provider Demographics
NPI:1548316979
Name:CHERRY HOSPITAL
Entity type:Organization
Organization Name:CHERRY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECTION CHIEF OF DMHDDSAS STATE OPE
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HENNIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:201 STEVENS MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1056
Mailing Address - Country:US
Mailing Address - Phone:919-731-3204
Mailing Address - Fax:919-731-3785
Practice Address - Street 1:201 STEVENS MILL ROAD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1056
Practice Address - Country:US
Practice Address - Phone:919-731-3204
Practice Address - Fax:919-731-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2656OtherBOARD OF PHARMACY