Provider Demographics
NPI:1700235397
Name:ACHIEVE BEYOND
Entity Type:Organization
Organization Name:ACHIEVE BEYOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST- AFFILIATE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-886-7633
Mailing Address - Street 1:11041 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2656
Mailing Address - Country:US
Mailing Address - Phone:646-717-3004
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST, SUITE 200
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-886-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY998586405251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health