1689120719 NPI number — ALTERNATIVES BEHAVIORAL HEALTH

Table of content: (NPI 1689120719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689120719 NPI number — ALTERNATIVES BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVES 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:
1689120719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 SPRING VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28405-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-233-5284
Provider Business Mailing Address Fax Number:
910-939-1430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 WALNUT ST
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401-4067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-233-5284
Provider Business Practice Location Address Fax Number:
910-939-1430
Provider Enumeration Date:
08/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TENTHOFF
Authorized Official First Name:
LEONA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
910-233-5284

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  S8202 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6104676 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com