Provider Demographics
NPI:1780011841
Name:NURSE EDUCATION DEVELPMENT CENTERS LLC
Entity Type:Organization
Organization Name:NURSE EDUCATION DEVELPMENT CENTERS LLC
Other - Org Name:PROVIDIAN BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:STELLETTE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:678-491-7870
Mailing Address - Street 1:3710 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3342
Mailing Address - Country:US
Mailing Address - Phone:678-372-8494
Mailing Address - Fax:
Practice Address - Street 1:3710 PREAKNESS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3342
Practice Address - Country:US
Practice Address - Phone:678-372-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health