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General NPI Number Information
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NPI Number | 1790508372
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Entity Type | Organization
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Legal Business Name | LONGBRANCH OUTPATIENT RECOVERY, LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2329 EDENBORN AVE
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City | METAIRIE
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State | LA
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Zip | 70001-1815
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Country | US
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Telephone | 504-635-3535
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Fax | 985-273-3869
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Provider Business Mailing Address
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Address Line | 2329 EDENBORN AVE
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City | METAIRIE
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State | LA
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Zip | 70001-1815
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Country | US
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Telephone | 504-635-3535
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Fax | 985-273-3869
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Authorized Official
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Title or Position | CEO
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Name | EMILY ELIZABETH MEYERS
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Credential |
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Telephone | 920-309-0541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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