Provider Demographics
NPI:1447437785
Name:SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
Entity type:Organization
Organization Name:SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-584-1105
Mailing Address - Street 1:PO BOX 3387
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-3387
Mailing Address - Country:US
Mailing Address - Phone:828-391-2803
Mailing Address - Fax:828-584-8910
Practice Address - Street 1:408 S GREEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3529
Practice Address - Country:US
Practice Address - Phone:828-430-9949
Practice Address - Fax:828-433-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908895Medicaid