Basic Information
| Provider Information | |||||||||
| NPI: | 1265702997 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORION BEHAVIORAL HEALTH NETWORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 241769 | ||||||||
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| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995241769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077702380 | ||||||||
| FaxNumber: | 9077702341 | ||||||||
| Practice Location | |||||||||
| Address1: | 17025 SNOWMOBILE LN | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995777044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072644390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2012 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | BEATY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9077702301 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0006X | 935267 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
No ID Information.