Provider Demographics
NPI:1154302586
Name:NORTHEAST BEHAVIORAL HEALTH CORPORATION
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL HEALTH CORPORATION
Other - Org Name:HEALTH AND EDUCATION SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-968-1712
Mailing Address - Street 1:199 ROSEWOOD DR STE 250
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1684
Mailing Address - Country:US
Mailing Address - Phone:978-968-1700
Mailing Address - Fax:
Practice Address - Street 1:800 CUMMINGS CENTER
Practice Address - Street 2:SUITE 266T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6172
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:978-927-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4770261QM0801X
MA0050372261QM2800X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA106214OtherMBC
MA1001430OtherBEACON
MA62-00062OtherEVERCARE-LICSW
MA15-00109OtherEVERCARE-MD
MA42702OtherMBC
MA61-00068OtherEVERCARE -PHD
MA83-00260OtherEVERCARE-RNCS
996119OtherNETWORK HEALTH
MA1300661Medicaid
MA106214OtherMBC
MA1312294Medicaid
MA1312308Medicaid
MA83-00260OtherEVERCARE-RNCS
MA106214OtherMBC
MA1310283Medicaid
MA15-00109OtherEVERCARE-MD
=========-MAOtherPACIFICARE-MA
MA106214OtherMBC
MA61-00068OtherEVERCARE -PHD
MA1312294Medicaid