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General NPI Number Information
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NPI Number | 1518776624
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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 | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 1111 S 5TH ST STE D&E
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City | LEESVILLE
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State | LA
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Zip | 71446-4927
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Country | US
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Telephone | 337-404-9998
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S 5TH ST STE D&E
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City | LEESVILLE
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State | LA
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Zip | 71446-4927
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Country | US
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Telephone | 337-404-9998
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | STEVE FILTON
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Credential |
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Telephone | 610-768-3482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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