NPIMap

Organization Active NPI

Henderson Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Lauderdale Lakes, FL
National Provider Identifier
1972533271
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HENDERSON BEHAVIORAL HEALTH, INC.
Practice address
4740 N State Road 7 Ste 201
Lauderdale Lakes, FL 33319-5839
Phone
(954) 497-3850
Fax
(954) 497-3857
NPI assigned
Jul 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erica Ricketts
Title
Cfo
Phone
(954) 777-1662

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary
Clinic/Center 261Q00000X
Assisted Living Facility (Mental Illness) 3104A0625X

Addresses

Primary practice location

4740 N State Road 7 Ste 201
Lauderdale Lakes, FL 33319-5839

Mailing address

4740 N State Road 7 Ste 201
Lauderdale Lakes, FL 33319-5804
Phone (954) 497-3850

Other identifiers 8

IdentifierTypeStateIssuer
060338403MedicaidFL
060338416MedicaidFL
060338410MedicaidFL
060338412MedicaidFL
060338408MedicaidFL
060330402MedicaidFL
060338417MedicaidFL
060338400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000676 FL Part B Supplier - Clinic/Group Practice 4688574643 Receives reassigned benefits from 42 practitioners
Practice locations: Hollywood, FL; Lauderhill, FL; Lauderdale Lakes, FL; Fort Lauderdale, FL; Davie, FL

National Provider Directory

National Provider Directory
Tax ID family
Henderson Mental HLTH C10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3501 S University Dr
Ste 6
Davie, FL 33328
Phone (954) 888-7965

3501 S University Dr
Davie, FL 33328
Phone (954) 888-7978

1957 Jackson St
Hollywood, FL 33020
Phone (954) 791-4300

4700 N State Road 7
Lauderdale Lakes, FL 33319
Phone (954) 730-7284

4720 N State Road 7
Lauderdale Lakes, FL 33319
Phone (954) 463-0911

5700 NW 27th Ct
Bldg D
Lauderhill, FL 33313
Phone (954) 497-3856

590 NW Peacock Blvd
Ste 10
Port St Lucie, FL 34986
Phone (772) 361-6767

2900 W Prospect Rd
Tamarac, FL 33309
Phone (954) 677-3113

7721 N Military Trl
Ste 35
West Palm Beach, FL 33410
Phone (561) 486-0848

Networks

  • HealthSun Health Plans Network
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners & affiliated clinicians

Practitioners 193

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 193

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1972533271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N STATE ROAD 7 STE 201",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195804",
            "telephone_number": "954-497-3850",
            "fax_number": "954-497-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N STATE ROAD 7 STE 201",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195839",
            "telephone_number": "954-497-3850",
            "fax_number": "954-497-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON BEHAVIORAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "RICKETTS",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "954-777-1662"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338403",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338416",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338410",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338412",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338408",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060330402",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338417",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060338400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.