1861781650 NPI number — ACADEMIC & BEHAVIORAL CENTER LLC

Table of content: (NPI 1861781650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861781650 NPI number — ACADEMIC & BEHAVIORAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACADEMIC & BEHAVIORAL CENTER 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:
1861781650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5425 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
#315
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-323-9835
Provider Business Mailing Address Fax Number:
520-327-2342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 N OLSEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85719-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-323-9835
Provider Business Practice Location Address Fax Number:
520-327-2342
Provider Enumeration Date:
04/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BYNES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
520-323-9835

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-2746 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z100597 . This is a "MEDICARE IDENTIFIER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com