Provider Demographics
NPI:1043705908
Name:VERDANT BEHAVIORAL HEALTH, A NURSING ORGANIZATION
Entity Type:Organization
Organization Name:VERDANT BEHAVIORAL HEALTH, A NURSING ORGANIZATION
Other - Org Name:VERDANT BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSAH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP - BC
Authorized Official - Phone:408-674-0310
Mailing Address - Street 1:125 E CAMPBELL AVE # 201
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7700
Mailing Address - Country:US
Mailing Address - Phone:408-508-6256
Mailing Address - Fax:408-608-0376
Practice Address - Street 1:125 E CAMPBELL AVE # 201
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7700
Practice Address - Country:US
Practice Address - Phone:408-508-6256
Practice Address - Fax:408-608-0376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERDANT BEHAVIORAL HEALTH, A NURSING ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty