1689897282 NPI number — OCEANS BEHAVIORAL HOSPITAL OF KENTWOOD, L.L.C.

Table of content: (NPI 1689897282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689897282 NPI number — OCEANS BEHAVIORAL HOSPITAL OF KENTWOOD, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEANS BEHAVIORAL HOSPITAL OF KENTWOOD, L.L.C.
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:
Provider Other Organization Name Type Code:
6
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:
1689897282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2021
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:
15782 PROFESSIONAL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-277-1415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

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: 04709722 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1702153 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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