Healthcare Provider Details

I. General information

NPI: 1467029587
Provider Name (Legal Business Name): BALANCE EATING DISORDER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W 21ST ST FL 4
NEW YORK NY
10010-6923
US

IV. Provider business mailing address

18 W 21ST ST FL 4
NEW YORK NY
10010-6923
US

V. Phone/Fax

Practice location:
  • Phone: 212-645-6903
  • Fax:
Mailing address:
  • Phone: 212-645-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: LAUREN SAADY SAXE
Title or Position: ADMINISTRATIVE COORDINATOR
Credential:
Phone: 813-541-4840