1144204926 NPI number — BEHAVIORAL HEALTH SERVICES

Table of content: (NPI 1144204926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144204926 NPI number — BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL HEALTH SERVICES
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:
1144204926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1767 N 2525 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-773-7177
Provider Business Mailing Address Fax Number:
801-498-7562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3225 W GORDON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-7177
Provider Business Practice Location Address Fax Number:
801-498-7562
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FAIRBANK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES/OWNER
Authorized Official Telephone Number:
801-773-7177

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000055010 . This is a "MEDICARE ID-PIN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com