Provider Demographics
NPI:1942411442
Name:BARIUM SPRINGS HOME FOR CHILDREN
Entity type:Organization
Organization Name:BARIUM SPRINGS HOME FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-832-2211
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BARIUM SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28010-0001
Mailing Address - Country:US
Mailing Address - Phone:704-873-1011
Mailing Address - Fax:704-832-2253
Practice Address - Street 1:115 BARIUM SPRINGS DRIVE
Practice Address - Street 2:NELSON HOME
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-6238
Practice Address - Country:US
Practice Address - Phone:704-873-1011
Practice Address - Fax:704-924-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604208Medicaid
NCMHL-049-109OtherMH LICENSE