Healthcare Provider Details

I. General information

NPI: 1023347895
Provider Name (Legal Business Name): CROWLEY PSYCHIATRIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N AVENUE G
CROWLEY LA
70526-4438
US

IV. Provider business mailing address

1526 N AVENUE G
CROWLEY LA
70526-2413
US

V. Phone/Fax

Practice location:
  • Phone: 337-785-8003
  • Fax: 337-785-8045
Mailing address:
  • Phone: 337-788-3380
  • Fax: 337-788-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number586
License Number StateLA

VIII. Authorized Official

Name: MS. KELLIE RENEE FOREMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-785-8003