Healthcare Provider Details

I. General information

NPI: 1982871307
Provider Name (Legal Business Name): MERIDIAN BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 10TH AVE NW
JASPER FL
32052-5844
US

IV. Provider business mailing address

1565 SW WILLISTON RD
GAINESVILLE FL
32608-4044
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-1338
  • Fax:
Mailing address:
  • Phone: 352-374-5600
  • Fax: 352-244-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAUREN COHN
Title or Position: SVP / CHIEF PERFORMANCE OFFICER
Credential:
Phone: 352-374-5600