Healthcare Provider Details

I. General information

NPI: 1588656581
Provider Name (Legal Business Name): BEACON BEHAVIORAL HEALTH-NEW ORLEANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 RIDGELAKE DR SUITE 100
METAIRIE LA
70002-4963
US

IV. Provider business mailing address

9938 AIRLINE HWY SUITE 200
BATON ROUGE LA
70816-8100
US

V. Phone/Fax

Practice location:
  • Phone: 504-581-4333
  • Fax: 504-561-8141
Mailing address:
  • Phone: 225-810-4040
  • Fax: 225-810-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: EARL J WILDE III
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 225-810-4040