Provider Demographics
NPI:1487709861
Name:CAROLINA BEHAVIORAL CARE, PA
Entity type:Organization
Organization Name:CAROLINA BEHAVIORAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:3530 STEFFISBURG DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8358
Mailing Address - Country:US
Mailing Address - Phone:480-529-6034
Mailing Address - Fax:
Practice Address - Street 1:209 MILLSTONE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8776
Practice Address - Country:US
Practice Address - Phone:919-245-5400
Practice Address - Fax:910-215-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905793Medicaid
NC5905793Medicaid