1902274525 NPI number — SEASIDE BEHAVIORAL CENTER, LLC

Table of content: (NPI 1902274525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902274525 NPI number — SEASIDE BEHAVIORAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEASIDE BEHAVIORAL CENTER, 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:
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:
1902274525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 FEU FOLLET DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-234-8455
Provider Business Mailing Address Fax Number:
337-234-8482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 WOODLAND DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-393-4223
Provider Business Practice Location Address Fax Number:
504-267-5692
Provider Enumeration Date:
09/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LANCASTER
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
318-841-2619

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  2203781725 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2700073 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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