Healthcare Provider Details

I. General information

NPI: 1023119989
Provider Name (Legal Business Name): GENESIS BEHAVIORAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 LATIOLAIS RD SUITE B
BREAUX BRIDGE LA
70517
US

IV. Provider business mailing address

847 STEWART ST
LAFAYETTE LA
70501-8539
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-4673
  • Fax: 337-237-4674
Mailing address:
  • Phone: 337-237-4673
  • Fax: 337-237-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number1702633
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number612
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIAM J ARLEDGE
Title or Position: CFO
Credential:
Phone: 337-237-4673