1730869926 NPI number — INTEGRATED BEHAVIORAL CARE, LLC

Table of content: (NPI 1730869926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730869926 NPI number — INTEGRATED BEHAVIORAL CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED BEHAVIORAL CARE, 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:
1730869926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
431 JOHNSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-886-2359
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MAIN ST STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMESBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01913-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-296-5595
Provider Business Practice Location Address Fax Number:
978-296-5592
Provider Enumeration Date:
07/21/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOUZAKIS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-886-2359

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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