Provider Demographics
NPI:1689719296
Name:PREMIER BEHAVIORAL SERVICES INC
Entity Type:Organization
Organization Name:PREMIER BEHAVIORAL SERVICES INC
Other - Org Name:PREMIER BEHAVIORAL SERVICES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTHOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-733-2007
Mailing Address - Street 1:2003 GODWIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3197
Mailing Address - Country:US
Mailing Address - Phone:910-671-1111
Mailing Address - Fax:910-671-4454
Practice Address - Street 1:2003 GODWIN AVE STE B
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3197
Practice Address - Country:US
Practice Address - Phone:910-671-1111
Practice Address - Fax:910-671-4454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER BEHAVIORAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408672Medicaid
NC8300573GMedicaid
NC6006152Medicaid
NC8300573HMedicaid
NC8300573BMedicaid