Provider Demographics
NPI:1730893215
Name:PRIME BEHAVIORAL HEALTH SERVICES INC.
Entity type:Organization
Organization Name:PRIME BEHAVIORAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELTAHIR MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MBBCH, LBS
Authorized Official - Phone:267-679-0464
Mailing Address - Street 1:234 SHADYBROOKE DR N
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 SHADYBROOKE DR N
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1317
Practice Address - Country:US
Practice Address - Phone:609-768-9748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health