Provider Demographics
NPI:1558892737
Name:AXXIOM BEHAVIORIAL HEALTH LLC
Entity Type:Organization
Organization Name:AXXIOM BEHAVIORIAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO, AND CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:K
Authorized Official - Last Name:CEASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-204-5060
Mailing Address - Street 1:241 SHEPARD AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2416
Mailing Address - Country:US
Mailing Address - Phone:973-204-5060
Mailing Address - Fax:
Practice Address - Street 1:241 SHEPARD AVE
Practice Address - Street 2:FL 2
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2416
Practice Address - Country:US
Practice Address - Phone:973-204-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXXIOM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health