Basic Information
| Provider Information | |||||||||
| NPI: | 1821487158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY BEHAVIORAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 LEE ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218045938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439449605 | ||||||||
| FaxNumber: | 8885090010 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 COURSEVALL DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216171835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442245264 | ||||||||
| FaxNumber: | 8885090010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2015 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | JANI | ||||||||
| AuthorizedOfficialFirstName: | NIRANJAN | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4439449605 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | D0037205 | MD | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 4226127 02 | 05 | MD | MEDICAID |