1568595171 NPI number — INTEGRATED BEHAVIOR SERVICES GROUP INC

Table of content: (NPI 1568595171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568595171 NPI number — INTEGRATED BEHAVIOR SERVICES GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED BEHAVIOR SERVICES GROUP 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:
1568595171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
07/26/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 S ST SE
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:
20020-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-610-1444
Provider Business Mailing Address Fax Number:
202-610-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 S ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-610-1444
Provider Business Practice Location Address Fax Number:
202-610-1445
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMBA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
202-610-0144

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  036003900 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036003900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".