1811949894 NPI number — SAMARITAN BEHAVIORAL HEALTH, INC.

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 1811949894 NPI number — SAMARITAN BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMARITAN BEHAVIORAL HEALTH, INC.
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:
6
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:
1811949894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S EDWIN C MOSES BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45417-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-734-4334
Provider Business Mailing Address Fax Number:
937-734-8269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2172 STATE ROUTE 127 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45320-9289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-456-1915
Provider Business Practice Location Address Fax Number:
937-456-2208
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASTERS
Authorized Official First Name:
TABATHA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
937-734-4334

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  503 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2433432 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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