Provider Demographics
NPI:1598311151
Name:BTC HEG, INC.
Entity Type:Organization
Organization Name:BTC HEG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-960-6830
Mailing Address - Street 1:4505 LAS VIRGENES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-880-0800
Mailing Address - Fax:818-880-8910
Practice Address - Street 1:1528 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4442
Practice Address - Country:US
Practice Address - Phone:818-880-0800
Practice Address - Fax:818-880-8910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BTC HEG, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No283Q00000XHospitalsPsychiatric Hospital