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NPI Code Detail

MEDICARE: BHG LVIII, LLC

MEDICARE: BHG LVIII, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1538791140
Entity Type Code : Organization
Provider Name (Legal Business Name) : BHG LVIII, LLC
Provider Business Mailing Address
First Line : 5001 SPRING VALLEY RD STE 600E
Second Line :
City : DALLAS
State : TX
Zip : 75244-8217
Country : US
Telephone Number : 214-365-6100
Fax Number : 214-365-6150
Provider Business Practice Location Address
First Line : 2705 OLIVET CHURCH ROAD
Second Line :
City : PADUCAH
State : KY
Zip : 42001-9755
Country : US
Telephone Number : 270-443-0096
Fax Number : 270-443-0080
Authorized Official
Title or Position : DIRECTOR OF LICENSING
Name : MRS. JEMECE MICHELLE GASAWAY
Credential : MSW. LMSW
Telephone Number : 214-365-6126
Provider Enumeration Date : 02/11/2020
Last Update Date : 02/11/2020

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