Provider Demographics
NPI:1417238338
Name:VIRTUS HEALTH, LLC
Entity Type:Organization
Organization Name:VIRTUS HEALTH, LLC
Other - Org Name:LOVELL GLASS BEHAVIOR THERAPY, DBA APPLIED BEHAVIOR HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP DIRECTOR OF CLIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:REILLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-312-3940
Mailing Address - Street 1:8237 VICELA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1462
Mailing Address - Country:US
Mailing Address - Phone:800-217-9289
Mailing Address - Fax:888-751-4019
Practice Address - Street 1:992 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3868
Practice Address - Country:US
Practice Address - Phone:941-374-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021044800Medicaid