Provider Demographics
NPI:1821789942
Name:AM BEHAVIORAL RESIDENTIAL LLC
Entity Type:Organization
Organization Name:AM BEHAVIORAL RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-231-1838
Mailing Address - Street 1:6210 BELLEFONTAINE RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4009
Mailing Address - Country:US
Mailing Address - Phone:937-236-1800
Mailing Address - Fax:937-237-1312
Practice Address - Street 1:6210 BELLEFONTAINE RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-4009
Practice Address - Country:US
Practice Address - Phone:937-236-1800
Practice Address - Fax:937-237-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility