Provider Demographics
NPI:1831465723
Name:ASCENSION BEHAVIORAL HEALTHCARE PA
Entity Type:Organization
Organization Name:ASCENSION BEHAVIORAL HEALTHCARE PA
Other - Org Name:ASCENSION BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-329-1915
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:452 LAKESHORE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4291
Practice Address - Country:US
Practice Address - Phone:803-329-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION BEHAVIORAL HEALTHCARE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site