1669451944 NPI number — LINCOLN BEHAVIORAL SERVICES

Table of content: (NPI 1669451944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669451944 NPI number — LINCOLN BEHAVIORAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN BEHAVIORAL SERVICES
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:
1669451944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9315 TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-450-4500
Provider Business Mailing Address Fax Number:
313-450-4514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9315 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-450-4500
Provider Business Practice Location Address Fax Number:
313-450-4514
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
313-450-4500

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OH26402 , issued by the state of ( MI ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: ON34160 , issued by the state of ( MI ) . This identifiers is of the category "MEDICARE PIN".