1528337706 NPI number — BEDFORD BEHAVIORAL HEALTH

Table of content: (NPI 1528337706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528337706 NPI number — BEDFORD BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEDFORD BEHAVIORAL HEALTH
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:
1528337706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8336 MONROE RD.
Provider Second Line Business Mailing Address:
RM 120
Provider Business Mailing Address City Name:
LAMBERTVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48144-9339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-807-0162
Provider Business Mailing Address Fax Number:
888-700-7159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8336 MONROE RD.
Provider Second Line Business Practice Location Address:
RM 120
Provider Business Practice Location Address City Name:
LAMBERTVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48144-9339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-807-0162
Provider Business Practice Location Address Fax Number:
888-700-7159
Provider Enumeration Date:
12/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUSH
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-807-0162

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401009357 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com