1154302586 NPI number — NORTHEAST BEHAVIORAL HEALTH CORPORATION

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154302586 NPI number — NORTHEAST BEHAVIORAL HEALTH CORPORATION

Employer Identification Number (EIN):

Provider Organization Name:

NORTHEAST BEHAVIORAL HEALTH CORPORATION

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

HEALTH AND EDUCATION SERVICES, INC.

Provider Other Organization Name Type Code:

4

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:

1154302586

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/19/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

199 ROSEWOOD DR STE 250

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DANVERS

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01923-1684

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-968-1700

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

800 CUMMINGS CENTER

Provider Second Line Business Practice Location Address:

SUITE 266T

Provider Business Practice Location Address City Name:

BEVERLY

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01915-6172

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-921-1190

Provider Business Practice Location Address Fax Number:

978-927-3724

Provider Enumeration Date:

11/11/2005

Authorized Official Last Name:

JACOBS

Authorized Official First Name:

HILARY

Authorized Official Middle Name:

Authorized Official Title or Position:

PRESIDENT

Authorized Official Telephone Number:

978-968-1712

• Taxonomy code: 261QM0801X , with the licence number:  4770 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 261QM2800X , with the licence number: 0050372 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 106214 . This is a "MBC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 1001430 . This is a "BEACON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 62-00062 . This is a "EVERCARE-LICSW" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 15-00109 . This is a "EVERCARE-MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 42702 . This is a "MBC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 61-00068 . This is a "EVERCARE -PHD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 83-00260 . This is a "EVERCARE-RNCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 996119 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".