Provider Demographics
NPI:1568115616
Name:DSTND4GR8NS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:DSTND4GR8NS BEHAVIORAL HEALTH LLC
Other - Org Name:DSTND4GR8NS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SATTERFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:CAC-ADS
Authorized Official - Phone:443-768-2215
Mailing Address - Street 1:9401 WHITE CEDAR DR APT 302
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-7523
Mailing Address - Country:US
Mailing Address - Phone:443-768-2215
Mailing Address - Fax:
Practice Address - Street 1:9401 WHITE CEDAR DR APT 302
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-7523
Practice Address - Country:US
Practice Address - Phone:443-768-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder