Basic Information
| Provider Information | |||||||||
| NPI: | 1922427517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASTRA BEHAVIORAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 340 | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427020340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705062730 | ||||||||
| FaxNumber: | 2709000704 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 RING RD | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427019454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705062730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | SAJID | ||||||||
| AuthorizedOfficialFirstName: | MUHAMMAD | ||||||||
| AuthorizedOfficialMiddleName: | WASIM | ||||||||
| AuthorizedOfficialTitleorPosition: | MD-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5026459054 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.