Provider Demographics
NPI:1740331693
Name:ABILENE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:ABILENE BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:830 CRESENT CENTRE DRIVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-861-6000
Mailing Address - Fax:615-261-9685
Practice Address - Street 1:4225 WOODS PLACE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602
Practice Address - Country:US
Practice Address - Phone:325-698-6600
Practice Address - Fax:325-698-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008460283Q00000X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454098Medicare Oscar/Certification