1033862875 NPI number — EMERGING HOPE BEHAVIORAL SERVICES, LLC

Table of content: (NPI 1033862875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033862875 NPI number — EMERGING HOPE BEHAVIORAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGING HOPE 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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033862875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5845 ROBERTDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKWOOD VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44146-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-224-7989
Provider Business Mailing Address Fax Number:
440-439-4548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5845 ROBERTDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKWOOD VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44146-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-224-7989
Provider Business Practice Location Address Fax Number:
440-439-4548
Provider Enumeration Date:
02/01/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TOWNS-SCOTT
Authorized Official First Name:
MATTIE
Authorized Official Middle Name:
DIANN
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
216-224-7080

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1065293 . This is a "BEACON HEALTH OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14656494 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDTS25493014 . This is a "OPTUM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5787580 . This is a "EVERNORTH CARE SOLUTIONS, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 0402056 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 601461575 . This is a "MAGELLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1341660 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5787580 . This is a "EVERNORTH CARE SOLUTIONS, INC" identifier . This identifiers is of the category "OTHER".




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