Healthcare Provider Details

I. General information

NPI: 1083296156
Provider Name (Legal Business Name): BEACON BEHAVIORAL HOSPITAL NORTHSHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64026 HIGHWAY 434 STE 300
LACOMBE LA
70445-5417
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 985-882-0226
  • Fax: 985-882-9853
Mailing address:
  • Phone: 225-810-4040
  • Fax: 225-810-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

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