1902100019 NPI number — ADVANTAGE BEHAVIORAL HEALTHCARE INC.

Table of content: (NPI 1902100019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902100019 NPI number — ADVANTAGE BEHAVIORAL HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE BEHAVIORAL HEALTHCARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902100019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 DAVIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-6002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-640-1038
Provider Business Mailing Address Fax Number:
910-640-1465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
732 DAVIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-640-1038
Provider Business Practice Location Address Fax Number:
910-640-1465
Provider Enumeration Date:
01/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
WALSTER
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
910-640-1038

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3418242 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3418282 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5906566 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302158B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303167R , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8702269 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302629G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5968204 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301619 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301619H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302158H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303168R , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301619B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302158G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005978 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303167 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303168 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302158 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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