Healthcare Provider Details

I. General information

NPI: 1932278140
Provider Name (Legal Business Name): OCEANS BEHAVIORAL HOSPITAL OF DERIDDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 BLANKENSHIP DRIVE
DERIDDER LA
70634
US

IV. Provider business mailing address

3905 HEDGCOXE RD UNIT 250249
PLANO TX
75025-0840
US

V. Phone/Fax

Practice location:
  • Phone: 337-460-9472
  • Fax: 337-460-9473
Mailing address:
  • Phone: 972-464-0022
  • Fax: 972-464-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number580
License Number StateLA

VIII. Authorized Official

Name: STUART ARCHER
Title or Position: CEO
Credential:
Phone: 972-464-0022