1205013000 NPI number — OCEANS BEHAVIORAL HOSPITAL OF OPELOUSAS, LLC

Table of content: (NPI 1205013000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205013000 NPI number — OCEANS BEHAVIORAL HOSPITAL OF OPELOUSAS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEANS BEHAVIORAL HOSPITAL OF OPELOUSAS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OCEANS BEHAVIORAL HOSPITAL OF OPELOUSAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205013000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3905 HEDGCOXE RD UNIT 250249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-0840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-464-0022
Provider Business Mailing Address Fax Number:
972-464-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 HEATHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELOUSAS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70570-7714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-948-8820
Provider Business Practice Location Address Fax Number:
337-948-8821
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARCHER
Authorized Official First Name:
STUART
Authorized Official Middle Name:
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
972-464-0022

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1704440 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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