Healthcare Provider Details

I. General information

NPI: 1750058202
Provider Name (Legal Business Name): P360 CARE SERVICES PLLC DBA PSYCH 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FRIENDSHIP CIR
BEAVER PA
15009-9704
US

IV. Provider business mailing address

PO BOX 7977
CAROL STREAM IL
60197-7977
US

V. Phone/Fax

Practice location:
  • Phone: 844-291-4535
  • Fax:
Mailing address:
  • Phone: 844-291-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIAN NICHOLS
Title or Position: SVP OF REVENUE OPERATIONS
Credential:
Phone: 615-334-5078