Provider Demographics
NPI:1972533271
Name:HENDERSON BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:HENDERSON BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-777-1662
Mailing Address - Street 1:4740 N STATE ROAD 7 STE 201
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5804
Mailing Address - Country:US
Mailing Address - Phone:954-497-3850
Mailing Address - Fax:954-497-3857
Practice Address - Street 1:4740 N STATE ROAD 7 STE 201
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5839
Practice Address - Country:US
Practice Address - Phone:954-497-3850
Practice Address - Fax:954-497-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060338403Medicaid
FL060338416Medicaid
FL060338410Medicaid
FL060338412Medicaid
FL060338408Medicaid
FL060330402Medicaid
FL060338417Medicaid
FL060338400Medicaid
FL060338408Medicaid