Acina Behavioral Health Solutions LLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Audubon, NJ
NPI 1982000741 · NPPES record last updated Jan 22, 2015
Key facts
- NPI
- 1982000741
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 26NJ00429100 (NJ)
- Legal business name
- ACINA BEHAVIORAL HEALTH SOLUTIONS LLC
- Practice address
- 618 S White Horse Pike FL 1
Audubon, NJ 08106-1315 - Phone
- (609) 350-4792
- NPI assigned
- Nov 6, 2014
- Organization subpart
- No
Authorized official
- Name
- Tyreasea A Johnson-Mason, APN
- Title
- Owner
- Phone
- (609) 350-4792
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150610001380 | NJ | Part B Supplier - Clinic/Group Practice | 0941521389 |
Receives reassigned benefits from 1 practitioner Practice locations: Haddon Township, NJ |
National Provider Directory
Locations
618 S White Horse Pike
Fl 1
Audubon, NJ 08106
Phone (609) 350-4792
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | 26NJ00429100 | NJ | Yes |
Addresses
Primary practice location
618 S White Horse Pike FL 1
Audubon, NJ 08106-1315
Mailing address
59 Grant LN
Berlin, NJ 08009-9469
Phone (609) 350-4792
Other providers in Audubon, NJ
- Lindsey B Ackley
- Acme Markets Inc
- Acme Markets Inc
- Steven Allia Jr.
- Alliance Adult Medical Day Care Services, LLC
All providers in Audubon, NJ · Psychiatric/Mental Health Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.