Provider Demographics
NPI:1225663644
Name:ANCHOBEHAVIORALHEALTH
Entity Type:Organization
Organization Name:ANCHOBEHAVIORALHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIEMEKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANUNKOR
Authorized Official - Suffix:
Authorized Official - Credentials:BEHAVIOR ANALYST
Authorized Official - Phone:626-428-6634
Mailing Address - Street 1:3356 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2314
Mailing Address - Country:US
Mailing Address - Phone:626-428-6634
Mailing Address - Fax:
Practice Address - Street 1:3356 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2314
Practice Address - Country:US
Practice Address - Phone:626-428-6634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities