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General NPI Number Information
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NPI Number | 1609105592
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Entity Type | Organization
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Legal Business Name | PREMIER BEHAVIORAL SERVICES INC
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 104 INDUSTRIAL PARK ROAD
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City | TABOR CITY
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State | NC
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Zip | 28463-1665
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Country | US
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Telephone | 910-653-3040
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Fax | 910-653-3040
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Provider Business Mailing Address
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Address Line | 2003 GODWIN AVE STE B
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City | LUMBERTON
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State | NC
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Zip | 28358-3150
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Country | US
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Telephone | 910-671-1111
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Fax | 910-671-4454
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANTHOSH AUGUSTINE
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Credential | MD
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Telephone | 910-733-2007
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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 | MHL 024 082
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License Number State | NC
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