Basic Information
| Provider Information | |||||||||
| NPI: | 1578060562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | N.C. BEHAVIORAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2686 | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925462686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513576959 | ||||||||
| FaxNumber: | 9513562115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S STATE ST STE A | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925437188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513576959 | ||||||||
| FaxNumber: | 9513562115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2018 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | CALDWELL | ||||||||
| AuthorizedOfficialFirstName: | NACHOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9512979505 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-9724 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1396133005 | 05 | CA | MEDICAID |