Provider Demographics
NPI:1720093347
Name:AHCS MENTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:AHCS MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:BERRY AND SWEENEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-794-1124
Mailing Address - Street 1:1377 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2101
Mailing Address - Country:US
Mailing Address - Phone:626-794-1124
Mailing Address - Fax:626-797-0424
Practice Address - Street 1:1377 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2101
Practice Address - Country:US
Practice Address - Phone:626-794-1124
Practice Address - Fax:626-797-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X
CAPHY534323336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720093347Medicaid
2155015OtherPK
5296330001Medicare NSC