Provider Demographics
NPI:1558885335
Name:ACCORD BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:ACCORD BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:614-859-2288
Mailing Address - Street 1:4589 KENNY RD STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2770
Mailing Address - Country:US
Mailing Address - Phone:614-859-2288
Mailing Address - Fax:614-750-1515
Practice Address - Street 1:4589 KENNY RD STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2770
Practice Address - Country:US
Practice Address - Phone:614-859-2288
Practice Address - Fax:614-750-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP10262261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health