1750991923 NPI number — ASPEN BEHAVIORAL HEALTH LLC

Table of content: (NPI 1750991923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750991923 NPI number — ASPEN BEHAVIORAL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPEN BEHAVIORAL HEALTH 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:
1750991923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 OSCEOLA DR STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33409-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-772-1295
Provider Business Mailing Address Fax Number:
561-532-0050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 OSCEOLA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200,300,108
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409-5075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-737-0963
Provider Business Practice Location Address Fax Number:
561-532-0050
Provider Enumeration Date:
08/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GERENA
Authorized Official First Name:
BIANCA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CREDENTIALING AND UR
Authorized Official Telephone Number:
561-502-4720

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 623212 . This is a "THE JOINT COMMISSION" identifier . This identifiers is of the category "OTHER".
  • Identifier: LIC-1047580 . This is a "DEPARTMENT OF CHILDREN AND FAMILIES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: LIC-1047579 . This is a "DEPARTMENT OF CHILDREN AND FAMILIES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: LIC-1047581 . This is a "DEPARTMENT OF CHILDREN AND FAMILIES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110944000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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