Provider Demographics
NPI:1710402631
Name:PREMIERE BEHAVIORAL SUPPORTS
Entity Type:Organization
Organization Name:PREMIERE BEHAVIORAL SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANSANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-861-5448
Mailing Address - Street 1:404 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1094
Mailing Address - Country:US
Mailing Address - Phone:856-861-5448
Mailing Address - Fax:856-599-8300
Practice Address - Street 1:291 GATEWOOD DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2902
Practice Address - Country:US
Practice Address - Phone:352-995-8861
Practice Address - Fax:856-599-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0588164Medicaid
FL114080800Medicaid
FL115254900Medicaid