Provider Demographics
NPI:1902504418
Name:SKILLED BEHAVIOR CARE
Entity Type:Organization
Organization Name:SKILLED BEHAVIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NECHAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-517-9562
Mailing Address - Street 1:30 COUNTRYSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12733-5821
Mailing Address - Country:US
Mailing Address - Phone:845-517-9562
Mailing Address - Fax:
Practice Address - Street 1:30 COUNTRYSIDE WAY
Practice Address - Street 2:
Practice Address - City:FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12733-5821
Practice Address - Country:US
Practice Address - Phone:845-517-9562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health