Healthcare Provider Details

I. General information

NPI: 1700124831
Provider Name (Legal Business Name): COMMUNITY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 COURSEVALL DR STE 107
CENTREVILLE MD
21617-1835
US

IV. Provider business mailing address

106 LEE ST
SALISBURY MD
21804-5938
US

V. Phone/Fax

Practice location:
  • Phone: 844-224-5264
  • Fax: 888-509-0010
Mailing address:
  • Phone: 443-944-9605
  • Fax: 888-509-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberD0037205
License Number StateMD

VIII. Authorized Official

Name: NIRANJAN N JANI
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-997-5500