Healthcare Provider Details

I. General information

NPI: 1922690106
Provider Name (Legal Business Name): BEACON BEHAVIORAL HOSPITAL - BATON ROUGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 BUNKER HILL DR
BATON ROUGE LA
70808-3303
US

IV. Provider business mailing address

4601 BLUEBONNET BLVD STE B
BATON ROUGE LA
70809-9656
US

V. Phone/Fax

Practice location:
  • Phone: 225-810-4040
  • Fax: 225-810-4050
Mailing address:
  • Phone: 225-810-4040
  • Fax: 225-810-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PHILLIP SEAN WENDELL
Title or Position: CEO
Credential: CPA
Phone: 225-810-4040