1467071928 NPI number — BHG LXIX, 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 1467071928 NPI number — BHG LXIX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHG LXIX, 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:
BHG HUNTSVILLE TREATMENT CENTER
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:
1467071928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 SPRING VALLEY RD STE 600E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75244-8217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-365-6100
Provider Business Mailing Address Fax Number:
214-365-6150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4040 INDEPENDENCE DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35816-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-721-1940
Provider Business Practice Location Address Fax Number:
256-721-1934
Provider Enumeration Date:
04/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GASAWAY
Authorized Official First Name:
JEMECE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF LICENSING
Authorized Official Telephone Number:
214-365-6126

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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