Provider Demographics
NPI:1427247550
Name:BEHAVIORAL HEALTH OF ORMOND BEACH
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH OF ORMOND BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP PA
Authorized Official - Phone:386-672-7470
Mailing Address - Street 1:533 N NOVA RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4422
Mailing Address - Country:US
Mailing Address - Phone:386-672-7470
Mailing Address - Fax:386-672-0771
Practice Address - Street 1:533 N NOVA RD STE 203
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4422
Practice Address - Country:US
Practice Address - Phone:386-672-7470
Practice Address - Fax:386-672-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4189Medicare PIN
FLS02080Medicare UPIN