1134394885 NPI number — OCEANS HOSPITAL OF ALEXANDRIA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134394885 NPI number — OCEANS HOSPITAL OF ALEXANDRIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEANS HOSPITAL OF ALEXANDRIA 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 ALEXANDRIA
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:
1134394885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2021
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:
2621 N BOLTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-448-8473
Provider Business Practice Location Address Fax Number:
318-448-8018
Provider Enumeration Date:
04/24/2008

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: 1704474 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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