Healthcare Provider Details

I. General information

NPI: 1104502525
Provider Name (Legal Business Name): FREEDOM BEHAVIORAL HOSPITAL OF LEESVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 PORT ARTHUR TER
LEESVILLE LA
71446
US

IV. Provider business mailing address

187 S TONTI DR
MANY LA
71449-5848
US

V. Phone/Fax

Practice location:
  • Phone: 337-802-1336
  • Fax:
Mailing address:
  • Phone: 504-337-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY JASON REED
Title or Position: CEO
Credential:
Phone: 337-802-1336