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General NPI Number Information
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NPI Number | 1003778911
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Entity Type | Organization
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Legal Business Name | AEGIS BEHAVIORAL HEALTH GROUP LLC
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Dates
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Enumeration Date | 11/29/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1001 S BRADFORD ST STE 2
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City | DOVER
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State | DE
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Zip | 19904-4153
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Country | US
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Telephone | 302-592-3780
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Fax | 302-291-1827
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Provider Business Mailing Address
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Address Line | 95-390 KUAHELANI AVE # 3AC-1008
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City | MILILANI
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State | HI
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Zip | 96789-1192
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Country | US
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Telephone | 808-746-3664
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Fax | 808-867-6537
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JASON RAMIREZ EALA
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Credential | PMHNP-BC
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Telephone | 808-746-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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