Healthcare Provider Details

I. General information

NPI: 1700460110
Provider Name (Legal Business Name): BHG LVII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BEACH ST
WESTERLY RI
02891-2718
US

IV. Provider business mailing address

5001 SPRING VALLEY RD STE 600
DALLAS TX
75244-3946
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-0969
  • Fax:
Mailing address:
  • Phone: 214-365-6100
  • Fax: 214-365-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONYA ROMERO
Title or Position: DIRECTOR OF PAYOR CREDENTIALING
Credential:
Phone: 208-450-5897