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General NPI Number Information
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NPI Number | 1164725701
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Entity Type | Organization
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Legal Business Name | BRENTWOOD ACQUISITION-SHREVEPORT INC.
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 1006 HIGHLAND AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4103
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Country | US
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Telephone | 318-678-7500
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Fax | 318-227-9296
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Provider Business Mailing Address
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Address Line | 1006 HIGHLAND AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4103
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Country | US
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Telephone | 318-678-7500
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Fax | 318-227-9296
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Authorized Official
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Title or Position | SR VP CFO
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Name | STEVE FILTON
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Credential |
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Telephone | 610-768-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 529
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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