Provider Demographics
NPI:1205519907
Name:AIMERGENCY CONNECT PSYCHCARE
Entity type:Organization
Organization Name:AIMERGENCY CONNECT PSYCHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-686-6577
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-0132
Mailing Address - Country:US
Mailing Address - Phone:954-686-6577
Mailing Address - Fax:954-245-0458
Practice Address - Street 1:1775 PARKER RD SE STE C210
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6676
Practice Address - Country:US
Practice Address - Phone:561-231-2594
Practice Address - Fax:833-449-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty