Provider Demographics
NPI:1669283818
Name:EMERGE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:EMERGE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OCIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-514-6761
Mailing Address - Street 1:6417 PENN AVE S STE 71113
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1186
Mailing Address - Country:US
Mailing Address - Phone:323-514-6761
Mailing Address - Fax:651-256-2963
Practice Address - Street 1:6417 PENN AVE S STE 71113
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423-1186
Practice Address - Country:US
Practice Address - Phone:323-514-6761
Practice Address - Fax:651-256-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health