1922372267 NPI number — BEHAVIORAL SUPPORT CENTER, LLC

Table of content: (NPI 1922372267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922372267 NPI number — BEHAVIORAL SUPPORT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL SUPPORT CENTER, LLC
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:
BSC
Provider Other Organization Name Type Code:
3
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:
1922372267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8546 BROADWAY ST
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78217-6376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-526-1806
Provider Business Mailing Address Fax Number:
210-547-7984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8546 BROADWAY ST BLDG C
Provider Second Line Business Practice Location Address:
BLDG C SUITE 200
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-6376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-526-1806
Provider Business Practice Location Address Fax Number:
210-547-7984
Provider Enumeration Date:
03/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YBARRA
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CEO/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
210-526-1806

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCDC TX: 12124 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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