1346570082 NPI number — EMERY BEHAVIORAL HEALTH SERVICES, INC

Table of content: (NPI 1346570082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346570082 NPI number — EMERY BEHAVIORAL HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERY BEHAVIORAL HEALTH SERVICES, 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:
1346570082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 WHISPER CREEK DR
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17837-7770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-522-0304
Provider Business Mailing Address Fax Number:
570-522-0475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SUNBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17801-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-286-0987
Provider Business Practice Location Address Fax Number:
570-286-0989
Provider Enumeration Date:
12/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
EMERY
Authorized Official First Name:
DUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT/DIRECTOR OF OPERATIO
Authorized Official Telephone Number:
570-522-0304

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS015898 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: SW013397L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: SW126648 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CW015380 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1019047770002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019581500001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1015177000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019060380002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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