1194894170 NPI number — BEHAVIORAL SCIENCE ASSOCIATES, INC.

Table of content: (NPI 1194894170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194894170 NPI number — BEHAVIORAL SCIENCE ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL SCIENCE ASSOCIATES, 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:
1194894170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 2 BOX 238
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRIADELPHIA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26059-9610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-336-9963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 14TH ST
Provider Second Line Business Practice Location Address:
SUITE 805
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-3433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-232-7295
Provider Business Practice Location Address Fax Number:
304-232-7296
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSH
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
304-336-9963

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  241 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9480101-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5097030 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 062476 . This is a "VALUE OPTIONS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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