1013223577 NPI number — HARDEN BEHAVIORAL SOLUTIONS, INC

Table of content: (NPI 1013223577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013223577 NPI number — HARDEN BEHAVIORAL SOLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARDEN BEHAVIORAL SOLUTIONS, 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:
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:
1013223577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30033-0023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-417-2779
Provider Business Mailing Address Fax Number:
435-417-2775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 RAVINIA DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30346-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-417-2779
Provider Business Practice Location Address Fax Number:
435-417-2775
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HARDEN
Authorized Official First Name:
BENITA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-417-2779

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002966 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 244385645B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com