Provider Demographics
NPI:1770271470
Name:ANCHOR BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:ANCHOR BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:808-731-9006
Mailing Address - Street 1:65-1206 MAMALAHOA HWY
Mailing Address - Street 2:BUILDING 2 OFFICE 3
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-731-9006
Mailing Address - Fax:
Practice Address - Street 1:65-1206 MAMALAHOA HWY
Practice Address - Street 2:BUILDING 2 OFFICE 3
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743
Practice Address - Country:US
Practice Address - Phone:808-731-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty