Provider Demographics
NPI:1306586169
Name:I SERVE BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:I SERVE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:860-995-4194
Mailing Address - Street 1:664 PROSPECT AVENUE. SUITE #100. HARTFORD, CT. 06105
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1636
Mailing Address - Country:US
Mailing Address - Phone:860-995-4194
Mailing Address - Fax:
Practice Address - Street 1:8 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1636
Practice Address - Country:US
Practice Address - Phone:860-995-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health