MEDICARE: YONDER BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1568100774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YONDER BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	330 HOTEL CT
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-8489
Country	:	US
Telephone Number	:	908-956-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 HOTEL CT
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-8489
Country	:	US
Telephone Number	:	908-956-5961
Fax Number	:

Authorized Official
Title or Position	:	VP, BUSINESS INTELLIGENCE
Name	:	CHRISTOPHER SHEEHAN
Credential	:
Telephone Number	:	908-956-5961

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	06/01/2022

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Directions to “YONDER BEHAVIORAL HEALTH ” Practice Location

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