Provider Demographics
NPI:1609040260
Name:BEHAVIORAL HEALTH SERVICES INCORPORATED
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-262-1786
Mailing Address - Street 1:3421 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-3030
Mailing Address - Country:US
Mailing Address - Phone:323-262-1786
Mailing Address - Fax:
Practice Address - Street 1:3421 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3030
Practice Address - Country:US
Practice Address - Phone:323-262-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH SERVICES INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR0802072146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR0802072146OtherRAS INTERN NUMBER