1487184511 NPI number — STEP-BY-STEP BEHAVIORAL HEALTH SERVICES, LLC

Table of content: (NPI 1487184511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487184511 NPI number — STEP-BY-STEP BEHAVIORAL HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEP-BY-STEP BEHAVIORAL HEALTH 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:
STEP-BY-STEP BEHAVIORAL HEALTH SERVICES, LLC
Provider Other Organization Name Type Code:
3
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:
1487184511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140435
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32614-0435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-408-9288
Provider Business Mailing Address Fax Number:
888-376-7135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 NW 8TH AVE STE B3-1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32601-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-763-7837
Provider Business Practice Location Address Fax Number:
888-376-7135
Provider Enumeration Date:
06/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
DESIREE
Authorized Official Middle Name:
CORLEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-408-9288

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 8698 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: MH8698 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 021961000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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