Healthcare Provider Details

I. General information

NPI: 1013547504
Provider Name (Legal Business Name): BEACON BEHAVIORAL HOSPITAL NEW ORLEANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 HAYNE BLVD STE 200
NEW ORLEANS LA
70128-1751
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 504-210-0460
  • Fax: 504-210-0970
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: MR. PHILLIP SEAN WENDELL
Title or Position: CEO
Credential:
Phone: 225-810-4040