Provider Demographics
NPI:1235312372
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
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-873-1011
Mailing Address - Street 1:156 FRAZIER LOOP
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-6238
Mailing Address - Country:US
Mailing Address - Phone:704-873-1011
Mailing Address - Fax:704-832-2253
Practice Address - Street 1:135 BURROUGHS LOOP
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-6238
Practice Address - Country:US
Practice Address - Phone:701-873-1011
Practice Address - Fax:704-832-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891266EMedicaid