MEDICARE: BHG LXXV, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1164196747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHG LXXV, LLC

Provider Business Mailing Address
First Line	:	5001 SPRING VALLEY ROAD
Second Line	:	SUITE 600 EAST
City	:	DALLAS
State	:	TX
Zip	:	75244
Country	:	US
Telephone Number	:	214-365-6100
Fax Number	:	214-365-6150

Provider Business Practice Location Address
First Line	:	1910 HASKELL AVE STE 9
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3296
Country	:	US
Telephone Number	:	785-856-4357
Fax Number	:	785-856-1127

Authorized Official
Title or Position	:	CEO
Name	:	JAY HIGHAM
Credential	:
Telephone Number	:	214-365-6100

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	12/26/2024

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