1356413736 NPI number — PICTURE HILLS BEHAVIORAL MEDICINE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356413736 NPI number — PICTURE HILLS BEHAVIORAL MEDICINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PICTURE HILLS BEHAVIORAL MEDICINE, 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:
1356413736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5652 MEADOW CT N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64152-6115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-584-9082
Provider Business Mailing Address Fax Number:
816-584-9083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5652 MEADOW CT N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64152-6115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-584-9082
Provider Business Practice Location Address Fax Number:
816-584-9083
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINTON
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-584-9082

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  104400 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 506051002 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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