1518124205 NPI number — BERKS BEHAVIORAL HEALTH, LLC

Table of content: (NPI 1528249927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518124205 NPI number — BERKS BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKS BEHAVIORAL HEALTH, 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:
6
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:
1518124205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 CATHEDRAL AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20008-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19601-3096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-378-2365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOYES
Authorized Official First Name:
GARRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
202-955-3990

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 220580 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 220610 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 220620 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102249372-0003 . This is a "MEDICAID PHYSICIAN GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 131695 . This is a "MEDICARE PART B PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102249372-0002 . This is a "MEDICAID OUTPATIENT PSYCHIATRIC CLINIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102249372-0001 . This is a "MEDICAID PARTIAL PSYCHIATRIC HOSPITAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102249372-0004 . This is a "MEDICAID INPATIENT PSYCHIATRIC HOSPITAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 394052 . This is a "MEDICARE PART A PTAN" identifier . This identifiers is of the category "OTHER".