Provider Demographics
NPI:1235390246
Name:BERRIEN MENTAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:BERRIEN MENTAL HEALTH AUTHORITY
Other - Org Name:RIVERWOOD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDLEFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-925-0585
Mailing Address - Street 1:1485 M 139
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-5711
Mailing Address - Country:US
Mailing Address - Phone:269-925-0585
Mailing Address - Fax:269-934-1610
Practice Address - Street 1:115 S SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2848
Practice Address - Country:US
Practice Address - Phone:269-684-4270
Practice Address - Fax:269-684-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910730OtherBLUE CROSS BLUE SHIELD
MI0N26020Medicare PIN