1093329468 NPI number — COMMUNITY BEHAVIORAL HEALTH, LLC

Table of content: (NPI 1093329468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093329468 NPI number — COMMUNITY BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY 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:
1093329468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 EASTERN SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-5943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-224-5264
Provider Business Mailing Address Fax Number:
888-509-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNOW HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21863-1048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-224-5264
Provider Business Practice Location Address Fax Number:
888-509-0010
Provider Enumeration Date:
09/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
LACY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIAL MANAGER
Authorized Official Telephone Number:
844-224-5264

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: 422612701 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com