Provider Demographics
NPI:1578910048
Name:ANCHOR BEHAVIOR CENTER LLC
Entity Type:Organization
Organization Name:ANCHOR BEHAVIOR CENTER LLC
Other - Org Name:ANCHOR BEHAVIOR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:704-614-7228
Mailing Address - Street 1:1207 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4466
Mailing Address - Country:US
Mailing Address - Phone:704-614-7228
Mailing Address - Fax:
Practice Address - Street 1:1207 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4466
Practice Address - Country:US
Practice Address - Phone:704-614-7228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health