1104568526 NPI number — BEHAVIORAL HEALTH SERVICES, INC.

Table of content: ELIZABETH A PARCELLA RD, CSP, CDN (NPI 1316324106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104568526 NPI number — BEHAVIORAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL HEALTH SERVICES, 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:
6
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:
1104568526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15519 CRENSHAW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90249-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-679-9126
Provider Business Mailing Address Fax Number:
310-679-7124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12021 SOUTH WILMINGTON AVE., BLDG #18, STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-454-6001
Provider Business Practice Location Address Fax Number:
833-969-0055
Provider Enumeration Date:
04/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BALLUE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
310-679-9126

Provider Taxonomy Codes

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

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





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