Provider Demographics
NPI:1578137196
Name:ASCELLUS BEHAVIORAL HEALTH SOLUTIONS PC
Entity Type:Organization
Organization Name:ASCELLUS BEHAVIORAL HEALTH SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-832-4999
Mailing Address - Street 1:6801 LAKE WORTH RD STE 308
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2966
Mailing Address - Country:US
Mailing Address - Phone:561-601-3092
Mailing Address - Fax:561-833-9333
Practice Address - Street 1:1267 WILLIS ST STE 200
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0400
Practice Address - Country:US
Practice Address - Phone:561-832-4999
Practice Address - Fax:561-833-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA118-40-4370OtherWORKERS COMPENSATION