Healthcare Provider Details

I. General information

NPI: 1225388507
Provider Name (Legal Business Name): COMPASS BEHAVIORAL CENTER OF ALEXANDRIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 MASONIC DRIVE
ALEXANDRIA LA
71301
US

IV. Provider business mailing address

6410 MASONIC DR
ALEXANDRIA LA
71301-2319
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0035
  • Fax: 318-443-0220
Mailing address:
  • Phone: 318-473-0035
  • Fax: 318-443-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateLA

VIII. Authorized Official

Name: MARK JON CULLEN
Title or Position: CFO
Credential:
Phone: 337-788-3330