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NPI Code Detail

MEDICARE: BEACON BEHAVIORAL HEALTH-BATON ROUGE INC

MEDICARE: BEACON BEHAVIORAL HEALTH-BATON ROUGE INC
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)

General Provider Information

NPI Number : 1699767699
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON BEHAVIORAL HEALTH-BATON ROUGE INC
Provider Business Mailing Address
First Line : 9938 AIRLINE HWY
Second Line : SUITE 200
City : BATON ROUGE
State : LA
Zip : 70816-8100
Country : US
Telephone Number : 225-810-4040
Fax Number : 225-810-4050
Provider Business Practice Location Address
First Line : 422 COLONIAL DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6505
Country : US
Telephone Number : 225-924-5655
Fax Number : 225-924-5330
Authorized Official
Title or Position : CHAIRMAN OF THE BOARD
Name : EARL J WILDE III
Credential :
Telephone Number : 225-810-4040
Provider Enumeration Date : 08/17/2005
Last Update Date : 08/22/2020

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