1538991500 NPI number — BROWN BEAR BEHAVIORAL HEALTH LLC

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 1538991500 NPI number — BROWN BEAR BEHAVIORAL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWN BEAR 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:
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:
1538991500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8625 WOODVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22153-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-409-6653
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 FORBES PL STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22151-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-409-6653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KACMAR
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
571-409-6653

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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