1184139131 NPI number — BEHAVIORAL OUTCOMES MANAGEMENT,LLC

Table of content: (NPI 1184139131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184139131 NPI number — BEHAVIORAL OUTCOMES MANAGEMENT,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL OUTCOMES MANAGEMENT,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:
EXPERTCARE MANAGEMENT SERVICES
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:
1184139131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 TOWN CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-1774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-643-8900
Provider Business Mailing Address Fax Number:
248-740-3505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 TOWN CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-1774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-643-8900
Provider Business Practice Location Address Fax Number:
248-740-3505
Provider Enumeration Date:
12/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SCLESKY
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-643-8900

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; 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: "Y" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MI9642 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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