Provider Demographics
NPI:1609247402
Name:ACHIEVE BEYOND
Entity Type:Organization
Organization Name:ACHIEVE BEYOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NJ REGIONAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-554-7205
Mailing Address - Street 1:89 BERNICE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1562
Mailing Address - Country:US
Mailing Address - Phone:973-508-6117
Mailing Address - Fax:
Practice Address - Street 1:581 MAIN ST STE 640
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1196
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILSKR834438479OtherBLUECROSS BLUESHIELD