Provider Demographics
NPI:1003778911
Name:AEGIS BEHAVIORAL HEALTH GROUP LLC
Entity type:Organization
Organization Name:AEGIS BEHAVIORAL HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RAMIREZ
Authorized Official - Last Name:EALA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:808-746-3664
Mailing Address - Street 1:95-390 KUAHELANI AVE # 3AC-1008
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1192
Mailing Address - Country:US
Mailing Address - Phone:808-746-3664
Mailing Address - Fax:808-867-6537
Practice Address - Street 1:1001 S BRADFORD ST STE 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-592-3780
Practice Address - Fax:302-291-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-29
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health