Provider Demographics
NPI:1730216656
Name:GREATER METROLINA MENTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GREATER METROLINA MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-865-5613
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-0219
Mailing Address - Country:US
Mailing Address - Phone:704-865-5613
Mailing Address - Fax:704-865-5614
Practice Address - Street 1:609 S NEW HOPE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4876
Practice Address - Country:US
Practice Address - Phone:704-865-5613
Practice Address - Fax:704-865-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300186BMedicaid
NC6005583Medicaid
NC8300186Medicaid