Healthcare Provider Details

I. General information

NPI: 1346775210
Provider Name (Legal Business Name): APPLEGATE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 W PRIEN LAKE RD SUITE L
LAKE CHARLES LA
70601-8386
US

IV. Provider business mailing address

3303 CENTRAL EXPY SUITE 210
PLANO TX
75023-6913
US

V. Phone/Fax

Practice location:
  • Phone: 337-540-7184
  • Fax:
Mailing address:
  • Phone: 972-578-2333
  • Fax: 972-578-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number00000
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRUCE MICHAEL JARVIE
Title or Position: VP, TREASURER
Credential:
Phone: 214-379-3300