Provider Demographics
NPI:1225205644
Name:MERIDIAN BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MERIDIAN BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP / CHIEF PERFORMANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-374-5600
Mailing Address - Street 1:1565 SW WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4044
Mailing Address - Country:US
Mailing Address - Phone:352-374-5600
Mailing Address - Fax:352-244-0280
Practice Address - Street 1:920 NW NOBLES FERRY ROAD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-362-4218
Practice Address - Fax:386-364-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL362344011Medicaid