Healthcare Provider Details

I. General information

NPI: 1376307009
Provider Name (Legal Business Name): ADVANCED BEHAVIORAL HEALTH CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 GLENN CROSS RD STE B
BATTLE CREEK MI
49015-4274
US

IV. Provider business mailing address

5470 GLENN CROSS RD
BATTLE CREEK MI
49015-4274
US

V. Phone/Fax

Practice location:
  • Phone: 269-550-0333
  • Fax:
Mailing address:
  • Phone: 269-550-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BELAL HEGAZY
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 269-550-0333