Provider Demographics
NPI:1427334952
Name:EBH ACQUISITION SUBSIDIARY
Entity type:Organization
Organization Name:EBH ACQUISITION SUBSIDIARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GANUES
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:615-567-7255
Mailing Address - Street 1:377 RIVERSIDE DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8964
Mailing Address - Country:US
Mailing Address - Phone:615-567-7250
Mailing Address - Fax:615-807-2931
Practice Address - Street 1:3100 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4327
Practice Address - Country:US
Practice Address - Phone:954-746-8232
Practice Address - Fax:954-746-8231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility