1841697034 NPI number — NORTHEAST BEHAVIORAL SERVCIES, 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 1841697034 NPI number — NORTHEAST BEHAVIORAL SERVCIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST BEHAVIORAL SERVCIES, 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:
PROMISES NEW JERSEY
Provider Other Organization Name Type Code:
3
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:
1841697034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 670646
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-0646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-567-7256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 BETHEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERS POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08244-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-641-0000
Provider Business Practice Location Address Fax Number:
609-377-5274
Provider Enumeration Date:
12/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MAPLESDEN
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, REVENUE CYCLE
Authorized Official Telephone Number:
615-510-3708

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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