Provider Demographics
NPI:1093314031
Name:PLEASANT BEHAVIORAL HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:PLEASANT BEHAVIORAL HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:410-298-7788
Mailing Address - Street 1:6314 WINDSOR MILL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6096
Mailing Address - Country:US
Mailing Address - Phone:410-298-7788
Mailing Address - Fax:410-298-7789
Practice Address - Street 1:7200 LAKE ELLENOR DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6200
Practice Address - Country:US
Practice Address - Phone:407-845-4444
Practice Address - Fax:407-845-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD237002600Medicaid