Healthcare Provider Details

I. General information

NPI: 1174387179
Provider Name (Legal Business Name): ASTRA IN BHE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/29/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 N EDDY ST STE 200
SOUTH BEND IN
46617-1478
US

IV. Provider business mailing address

1251 N EDDY ST STE 200
SOUTH BEND IN
46617-1478
US

V. Phone/Fax

Practice location:
  • Phone: 919-200-0240
  • Fax:
Mailing address:
  • Phone: 919-200-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: EITAN ADAMS
Title or Position: MANAGER
Credential:
Phone: 919-200-0240