Provider Demographics
NPI:1750991923
Name:ASPEN BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ASPEN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND UR
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-502-4720
Mailing Address - Street 1:900 OSCEOLA DR STE 108
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5000
Mailing Address - Country:US
Mailing Address - Phone:833-772-1295
Mailing Address - Fax:561-532-0050
Practice Address - Street 1:900 OSCEOLA DRIVE
Practice Address - Street 2:SUITE 200,300,108
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5075
Practice Address - Country:US
Practice Address - Phone:833-737-0963
Practice Address - Fax:561-532-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLIC-1047579OtherDEPARTMENT OF CHILDREN AND FAMILIES
FLLIC-1047580OtherDEPARTMENT OF CHILDREN AND FAMILIES
FLLIC-1047581OtherDEPARTMENT OF CHILDREN AND FAMILIES
623212OtherTHE JOINT COMMISSION