Provider Demographics
NPI:1053073940
Name:ESHCOL BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:ESHCOL BEHAVIORAL SERVICES LLC
Other - Org Name:ESHCOL BEHAVIORAL SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AKHERE
Authorized Official - Middle Name:
Authorized Official - Last Name:GWAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-461-3856
Mailing Address - Street 1:6223 SWEET GUM LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6223 SWEET GUM LN
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2127
Practice Address - Country:US
Practice Address - Phone:617-461-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty