Healthcare Provider Details

I. General information

NPI: 1417685264
Provider Name (Legal Business Name): SUPERIOR BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 TRANSPORTATION BLVD
GARFIELD HEIGHTS OH
44125-5327
US

IV. Provider business mailing address

PO BOX 687
MONROE NY
10949-0687
US

V. Phone/Fax

Practice location:
  • Phone: 917-636-0522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MORDECHAI FRIEDMAN
Title or Position: OWNER
Credential:
Phone: 917-636-0522