Provider Demographics
NPI:1275956807
Name:GEORGETOWN BEHAVIORAL HEALTH INSTITUTE, LLC
Entity Type:Organization
Organization Name:GEORGETOWN BEHAVIORAL HEALTH INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-905-5091
Mailing Address - Street 1:29433 SOUTHFIELD RD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2031
Mailing Address - Country:US
Mailing Address - Phone:248-905-5091
Mailing Address - Fax:248-905-5096
Practice Address - Street 1:3101 S. AUSTIN AVENUE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626
Practice Address - Country:US
Practice Address - Phone:248-905-5091
Practice Address - Fax:248-905-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital