Healthcare Provider Details

I. General information

NPI: 1124355128
Provider Name (Legal Business Name): SEASIDE BEHAVIORAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 COLISEUM ST
NEW ORLEANS LA
70115-3606
US

IV. Provider business mailing address

3601 COLISEUM ST
NEW ORLEANS LA
70115-3606
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-4223
  • Fax:
Mailing address:
  • Phone: 504-393-4223
  • Fax: 504-218-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateLA

VIII. Authorized Official

Name: SHERRY CAMPBELL
Title or Position: CEO
Credential: BSBA-HRM, SHRM-CP
Phone: 504-393-4223