Healthcare Provider Details

I. General information

NPI: 1407207863
Provider Name (Legal Business Name): ALLEGIANCE HEALTH CENTER OF RUSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 STERLINGTON RD
MONROE LA
71203-2338
US

IV. Provider business mailing address

4402 STERLINGTON RD
MONROE LA
71203-2338
US

V. Phone/Fax

Practice location:
  • Phone: 318-255-8085
  • Fax:
Mailing address:
  • Phone: 318-966-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number599
License Number StateLA

VIII. Authorized Official

Name: DONALD E. CAMERON
Title or Position: DIRECTOR
Credential:
Phone: 318-226-8202