Basic Information
| Provider Information | |||||||||
| NPI: | 1154928406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIOR CARE SPECIALISTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2804 E 26TH ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571034019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6059068724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11601 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900250509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052712690 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2020 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | FEHRMAN | ||||||||
| AuthorizedOfficialFirstName: | JESSIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6059068806 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEHAVIOR CARE SPECIALISTS, INC | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | N | 193200000X MULTI-SPECIALTY GROUP | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.