1962558015 NPI number — BEHAVIORAL HEALTH CENTER, INC.

Table of content: (NPI 1962558015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962558015 NPI number — BEHAVIORAL HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL HEALTH CENTER, 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:
1962558015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33316 HEAVENLY WAY STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN VIEW
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19970-3473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-567-1695
Provider Business Mailing Address Fax Number:
302-616-3934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32828 REBA RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLVILLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19967-6909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-567-1695
Provider Business Practice Location Address Fax Number:
302-616-3934
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOHR
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
302-567-1695

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY636 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A0217719 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 217075 . This is a "SUMMERLIN (HMN)" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: A217719 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PSY-636 . This is a "MDX" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 50138903 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50138904 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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