Provider Demographics
NPI:1295447506
Name:BDAACH
Entity type:Organization
Organization Name:BDAACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAP CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:HUICHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-737-4297
Mailing Address - Street 1:549TH HOSPITAL CENTER/BDAACH UNIT# 15245
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WOOD PCMH (CP WALKER)
Practice Address - Street 2:BLDG #226
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96218
Practice Address - Country:KR
Practice Address - Phone:315-737-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty