1598874414 NPI number — INTEGRATED BEHAVIORAL HEALTHCARE MANAGEMENT SERVICES, INC.

Table of content: (NPI 1598874414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598874414 NPI number — INTEGRATED BEHAVIORAL HEALTHCARE MANAGEMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED BEHAVIORAL HEALTHCARE MANAGEMENT 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:
HUNTINGDON COUNSELING AND PSYCHIATRIC SERVICES
Provider Other Organization Name Type Code:
3
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:
1598874414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 BRYAN STREET
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-643-6300
Provider Business Mailing Address Fax Number:
814-643-8776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 BRYAN ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-6300
Provider Business Practice Location Address Fax Number:
814-643-8776
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
814-643-6300

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  313180 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 313180 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 313180 , 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: 1359155 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100746486 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1350119 . This is a "BLUE SHIELD (MANAGED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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