Provider Demographics
NPI:1669758355
Name:EBH ACQUISITION SUBSIDIARY, INC
Entity type:Organization
Organization Name:EBH ACQUISITION SUBSIDIARY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-741-6471
Mailing Address - Street 1:3100 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4327
Mailing Address - Country:US
Mailing Address - Phone:954-200-8308
Mailing Address - Fax:
Practice Address - Street 1:3100 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4327
Practice Address - Country:US
Practice Address - Phone:954-200-8308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEMENTS BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility