Organization
HENDERSON BEHAVIORAL HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA RICKETTS (CFO)
(954) 777-1662
Entity
Organization
Contact information
Practice address
4740 N STATE ROAD 7 STE 201, LAUDERDALE LAKES, FL 33319-5839
(954) 497-3850
(954) 497-3857
Mailing address
4740 N STATE ROAD 7 STE 201, LAUDERDALE LAKES, FL 33319-5804
(954) 497-3850
(954) 497-3857
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060330402
—
FL
05
—
060338400
—
FL
05
—
060338403
—
FL
05
—
060338408
—
FL
05
—
060338410
—
FL
05
—
060338412
—
FL
05
—
060338416
—
FL
05
—
060338417
—
FL
Enumeration date
07/03/2006
Last updated
01/20/2012
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