Basic Information
| Provider Information | |||||||||
| NPI: | 1689621468 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL HEALTH SERVICES NORTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 US OVAL STE 218 | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129035902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185638000 | ||||||||
| FaxNumber: | 5185639001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 STATE ROUTE 22B | ||||||||
| Address2: | |||||||||
| City: | MORRISONVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185638000 | ||||||||
| FaxNumber: | 5185639001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | LUKENS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5185638206 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 00671747 | 05 | NY | MEDICAID | 01405650 | 05 | NY | MEDICAID | 01085758 | 05 | NY | MEDICAID | 01285083 | 05 | NY | MEDICAID |