1578137196 NPI number — ASCELLUS BEHAVIORAL HEALTH SOLUTIONS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578137196 NPI number — ASCELLUS BEHAVIORAL HEALTH SOLUTIONS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCELLUS BEHAVIORAL HEALTH SOLUTIONS PC
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:
1578137196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 LAKE WORTH RD STE 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33467-2966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-601-3092
Provider Business Mailing Address Fax Number:
561-833-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1267 WILLIS ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-832-4999
Provider Business Practice Location Address Fax Number:
561-833-9333
Provider Enumeration Date:
05/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SACK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-832-4999

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118-40-4370 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com