1669248670 NPI number — EVEREST WELLNESS & BEHAVIORAL SERVICES LLC

Table of content: (NPI 1669248670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669248670 NPI number — EVEREST WELLNESS & BEHAVIORAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVEREST WELLNESS & BEHAVIORAL SERVICES 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1669248670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29749 PICANA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33543-6652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-538-1546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 TOWN SQUARE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07310-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-374-7881
Provider Business Practice Location Address Fax Number:
201-502-9310
Provider Enumeration Date:
11/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SHRESTHA
Authorized Official First Name:
MANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRIC NURSE PRACTITIONER
Authorized Official Telephone Number:
201-374-7881

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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