1922145184 NPI number — BEHAVIORAL SUPPORT SERVICES, INC.

Table of content: (NPI 1922145184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922145184 NPI number — BEHAVIORAL SUPPORT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL SUPPORT SERVICES, 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:
1922145184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 DOUGLAS AVE
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-5206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-830-6412
Provider Business Mailing Address Fax Number:
407-830-8413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 DOUGLAS AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-5206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-830-6412
Provider Business Practice Location Address Fax Number:
407-830-8413
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERLEY
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CRO
Authorized Official Telephone Number:
407-830-6412

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  GH203 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 550531 . This is a "VALUE OPTIONS, MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 678222196 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 307161 . This is a "UNITED HMO MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 678222198 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 765763300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 272081 . This is a "AMERIGROUP HMO MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 281886 . This is a "HARMONY HMO MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: GH203 . This is a "STATE SAMH OFFICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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