1962114389 NPI number — HIGHER GROUND BEHAVIORAL HEALTH LLC

Table of content: (NPI 1962114389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962114389 NPI number — HIGHER GROUND BEHAVIORAL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHER GROUND BEHAVIORAL HEALTH 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:
1962114389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 HADDONFIELD BERLIN RD STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-809-2940
Provider Business Mailing Address Fax Number:
610-765-1265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 HADDONFIELD BERLIN RD STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-809-2940
Provider Business Practice Location Address Fax Number:
610-765-1265
Provider Enumeration Date:
12/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DEMARCO
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
856-809-2940

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com