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NPI Code Detail

MEDICARE: BEACON BEHAVIORAL HOSPITAL LLC

MEDICARE: BEACON BEHAVIORAL HOSPITAL 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1194102OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891328787
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON BEHAVIORAL HOSPITAL LLC
Provider Business Mailing Address
First Line : 4601 BLUEBONNET BLVD STE B
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-9656
Country : US
Telephone Number : 225-810-4040
Fax Number : 225-810-4050
Provider Business Practice Location Address
First Line : 10425 PLAZA AMERICANA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-8188
Country : US
Telephone Number : 225-810-4719
Fax Number : 225-810-4722
Authorized Official
Title or Position : CEO
Name : MR. PHILLIP SEAN WENDELL
Credential :
Telephone Number : 225-810-4040
Provider Enumeration Date : 02/19/2020
Last Update Date : 12/24/2020

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Directions to “BEACON BEHAVIORAL HOSPITAL LLC ” Practice Location

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