Provider Demographics
NPI:1043458375
Name:PARKWAY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PARKWAY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-254-5008
Mailing Address - Street 1:31 COLLEGE PL
Mailing Address - Street 2:B100
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2483
Mailing Address - Country:US
Mailing Address - Phone:828-254-5008
Mailing Address - Fax:828-254-5808
Practice Address - Street 1:31 COLLEGE PL STE B100
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2400
Practice Address - Country:US
Practice Address - Phone:828-254-5008
Practice Address - Fax:828-254-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL011273251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018PVOtherBCBS
NC8301723FMedicaid
NC8301723GMedicaid
NC8301723QMedicaid
NC8301723Medicaid
NC8301723BMedicaid
NC2343165Medicare PIN