Provider Demographics
NPI:1467236075
Name:ASPEN BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ASPEN BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UR AND CREDENTIALING
Authorized Official - Prefix:DR
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-502-4720
Mailing Address - Street 1:642 W RAMBLING DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5024
Mailing Address - Country:US
Mailing Address - Phone:561-502-4720
Mailing Address - Fax:561-532-0050
Practice Address - Street 1:642 W RAMBLING DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5024
Practice Address - Country:US
Practice Address - Phone:561-502-4720
Practice Address - Fax:561-532-0050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN BEHAVIORAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility