# EAST CENTRAL BEHAVIORAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194421255
- **Authorized official:** JEREMIAH RANDALL CNP, APRN, PMHNP-BC (OWNER)
- **Authorized official phone:** (320) 223-0467

## Contact information

- **Practice address:** 841 FOREST AVE E STE 210, MORA, MN 55051-1627
- **Practice address phone:** (320) 244-2451
- **Practice address fax:** (320) 238-7497
- **Mailing address:** PO BOX 202, OGILVIE, MN 56358-0202
- **Mailing address phone:** (320) 223-0467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2023
- **Last updated:** 02/01/2023