Provider Demographics
NPI:1871374876
Name:ENVIRO-MENTAL BEHAVIOR GROUP, LLC
Entity type:Organization
Organization Name:ENVIRO-MENTAL BEHAVIOR GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-803-0316
Mailing Address - Street 1:1215 MACOY DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-9837
Mailing Address - Country:US
Mailing Address - Phone:336-803-0316
Mailing Address - Fax:
Practice Address - Street 1:416 MCCAIN RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NC
Practice Address - Zip Code:27305-9402
Practice Address - Country:US
Practice Address - Phone:336-803-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child