Provider Demographics
NPI:1215275466
Name:COMMUNITY BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:COMMUNITY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIRANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:443-944-9605
Mailing Address - Street 1:106 LEE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5938
Mailing Address - Country:US
Mailing Address - Phone:443-944-9605
Mailing Address - Fax:888-509-0010
Practice Address - Street 1:426 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2446
Practice Address - Country:US
Practice Address - Phone:844-224-5264
Practice Address - Fax:888-509-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037205251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4214455-01Medicaid