Basic Information
| Provider Information | |||||||||
| NPI: | 1154302586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST BEHAVIORAL HEALTH CORPORATION | ||||||||
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| OtherOrganizationName: | HEALTH AND EDUCATION SERVICES, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 ROSEWOOD DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019231684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789681700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 CUMMINGS CENTER | ||||||||
| Address2: | SUITE 266T | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789211190 | ||||||||
| FaxNumber: | 9789273724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | JACOBS | ||||||||
| AuthorizedOfficialFirstName: | HILARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9789681712 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | 0050372 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 261QM0801X | 4770 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 106214 | 01 | MA | MBC | OTHER | 1001430 | 01 | MA | BEACON | OTHER | 62-00062 | 01 | MA | EVERCARE-LICSW | OTHER | 15-00109 | 01 | MA | EVERCARE-MD | OTHER | 42702 | 01 | MA | MBC | OTHER | 61-00068 | 01 | MA | EVERCARE -PHD | OTHER | 83-00260 | 01 | MA | EVERCARE-RNCS | OTHER | 996119 | 01 | NETWORK HEALTH | OTHER |