1326322033 NPI number — SANDCREEK BEHAVIORAL HEALTH GROUP, LLC

Table of content: NICHOLAS ADAM HOWARD MD (NPI 1710423348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326322033 NPI number — SANDCREEK BEHAVIORAL HEALTH GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDCREEK BEHAVIORAL HEALTH GROUP, 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:
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:
1326322033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2629 TILBURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALSTEAD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67056-9377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-212-6287
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-212-6287
Provider Business Practice Location Address Fax Number:
316-283-1142
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOOFER
Authorized Official First Name:
JOY
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
316-212-6287

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1658 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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