Healthcare Provider Details

I. General information

NPI: 1720345663
Provider Name (Legal Business Name): SEASIDE HEALTH SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4363 CONVENTION ST
BATON ROUGE LA
70806-3906
US

IV. Provider business mailing address

4363 CONVENTION ST
BATON ROUGE LA
70806-3906
US

V. Phone/Fax

Practice location:
  • Phone: 225-522-4076
  • Fax: 225-522-4076
Mailing address:
  • Phone: 225-522-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA RYAN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 337-345-5110