1588709646 NPI number — PERSPECTIVES BEHAVIORAL HEALTH MANAGEMENT, LLC

Table of content: (NPI 1588709646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588709646 NPI number — PERSPECTIVES BEHAVIORAL HEALTH MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSPECTIVES BEHAVIORAL HEALTH MANAGEMENT, 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:
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:
1588709646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARLING
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72923-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-452-5040
Provider Business Mailing Address Fax Number:
479-452-5047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 FORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARLING
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72923-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-434-5002
Provider Business Practice Location Address Fax Number:
479-434-5009
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
KERRI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO-INTERIM
Authorized Official Telephone Number:
479-452-5040

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 171893526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171894526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171896526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174972526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5GA77 . This is a "MEDICARE ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 171892526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171895526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171897526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171898526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171899526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156877526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171901526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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