Provider Demographics
NPI:1548420649
Name:COMPREHENSIVE BEHAVIORAL HEALTH MGMT
Entity Type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL HEALTH MGMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCIAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-467-5419
Mailing Address - Street 1:17100 PIONEER BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90701-2754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17100 PIONEER BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-2754
Practice Address - Country:US
Practice Address - Phone:562-467-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization