Provider Demographics
NPI:1285640961
Name:SOUTH PENINSULA BEHAVIORAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SOUTH PENINSULA BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:COMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHTOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-9229
Mailing Address - Street 1:3948 BEN WALTERS LN
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7708
Mailing Address - Country:US
Mailing Address - Phone:907-235-7701
Mailing Address - Fax:
Practice Address - Street 1:3948 BEN WALTERS LN
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7708
Practice Address - Country:US
Practice Address - Phone:907-235-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020987Medicaid
AK1020987Medicaid