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NPI Code Detail

MEDICARE: LONGBRANCH OUTPATIENT RECOVERY, LLC

MEDICARE: LONGBRANCH OUTPATIENT RECOVERY, 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)
2261QR0800XRecovery Care Clinic/Center

General Provider Information

NPI Number : 1790508372
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONGBRANCH OUTPATIENT RECOVERY, LLC
Provider Business Mailing Address
First Line : 2329 EDENBORN AVE
Second Line :
City : METAIRIE
State : LA
Zip : 70001-1815
Country : US
Telephone Number : 504-635-3535
Fax Number : 985-273-3869
Provider Business Practice Location Address
First Line : 2329 EDENBORN AVE
Second Line :
City : METAIRIE
State : LA
Zip : 70001-1815
Country : US
Telephone Number : 504-635-3535
Fax Number : 985-273-3869
Authorized Official
Title or Position : CEO
Name : EMILY ELIZABETH MEYERS
Credential :
Telephone Number : 920-309-0541
Provider Enumeration Date : 11/04/2024
Last Update Date : 11/04/2024

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