Provider Demographics
NPI:1841568573
Name:NEURO BALANCE AND BEHAVIORAL CENTER INC
Entity Type:Organization
Organization Name:NEURO BALANCE AND BEHAVIORAL CENTER INC
Other - Org Name:PURE BALANCE BODY AND MIND CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AREVIK
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:ARAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:818-245-8133
Mailing Address - Street 1:427 W COLORADO ST STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3045
Mailing Address - Country:US
Mailing Address - Phone:818-245-8133
Mailing Address - Fax:818-245-8134
Practice Address - Street 1:427 W COLORADO ST STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3045
Practice Address - Country:US
Practice Address - Phone:818-245-8133
Practice Address - Fax:818-245-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPZUC1119500302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization