Provider Demographics
NPI:1407512536
Name:EBERTHS BEHAVIORAL GROUP II LLC
Entity Type:Organization
Organization Name:EBERTHS BEHAVIORAL GROUP II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-814-4127
Mailing Address - Street 1:11340 LAKEFIELD DRIVE
Mailing Address - Street 2:STE 200/276
Mailing Address - City:JOHN CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-814-4127
Mailing Address - Fax:
Practice Address - Street 1:11340 LAKEFIELD DRIVE
Practice Address - Street 2:STE 200/276
Practice Address - City:JOHN CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-814-4127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)