Provider Demographics
NPI: | 1659545978 |
---|---|
Name: | JBH BEHAVIORAL HEALTH SYSTEMS LLC |
Entity Type: | Organization |
Organization Name: | JBH BEHAVIORAL HEALTH SYSTEMS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | TEHJAN |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RNC |
Authorized Official - Phone: | 239-848-6515 |
Mailing Address - Street 1: | 4113 W RIVERSIDE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT MYERS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33901-8732 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-936-1114 |
Mailing Address - Fax: | 239-936-5968 |
Practice Address - Street 1: | 12550 NEW BRITTANY BLVD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | FORT MYERS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33907-3655 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-936-1114 |
Practice Address - Fax: | 239-936-5968 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-04-17 |
Last Update Date: | 2008-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |