1346410172 NPI number — PHOENIX BEHAVIORAL HOSPITAL OF EUNICE, LLC

Table of content: (NPI 1346410172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346410172 NPI number — PHOENIX BEHAVIORAL HOSPITAL OF EUNICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX BEHAVIORAL HOSPITAL OF EUNICE, 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:
PHOENIX BEHAVIORAL HOSPITAL
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:
1346410172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4333 SHREVEPORT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-445-6470
Provider Business Mailing Address Fax Number:
318-641-3745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 CROWLEY RAYNE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYNE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-788-0091
Provider Business Practice Location Address Fax Number:
866-933-1140
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
318-641-3717

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 283Q00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1704491 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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