Healthcare Provider Details

I. General information

NPI: 1346410172
Provider Name (Legal Business Name): PHOENIX BEHAVIORAL HOSPITAL OF EUNICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CROWLEY RAYNE HWY
RAYNE LA
70578
US

IV. Provider business mailing address

4333 SHREVEPORT HWY
PINEVILLE LA
71360
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-0091
  • Fax: 866-933-1140
Mailing address:
  • Phone: 318-445-6470
  • Fax: 318-641-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. JAMES E RICHARDSON
Title or Position: CEO
Credential:
Phone: 318-641-3717