Healthcare Provider Details

I. General information

NPI: 1205503786
Provider Name (Legal Business Name): BHG LIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 WESTERN BRAND BLVD SUITE A
CHESAPEAKE VA
23321-5142
US

IV. Provider business mailing address

5001 SPRING VALLEY ROAD SUITE 600 EAST
DALLAS TX
75244-8217
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-3644
  • Fax: 757-337-0165
Mailing address:
  • Phone: 214-365-6100
  • Fax: 214-365-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAY HIGHAM
Title or Position: CEO
Credential:
Phone: 214-365-6112