MEDICARE: BHG LXXXV, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1114632288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHG LXXXV, LLC

Provider Business Mailing Address
First Line	:	5001 SPRING VALLEY ROAD
Second Line	:	SUITE 600 EAST
City	:	DALLAS
State	:	TX
Zip	:	75244-3946
Country	:	US
Telephone Number	:	214-365-6100
Fax Number	:	214-365-6150

Provider Business Practice Location Address
First Line	:	2123 E. SOUTHERN AVENUE
Second Line	:	OBOT ROOM #100
City	:	TEMPE
State	:	AZ
Zip	:	85282-7531
Country	:	US
Telephone Number	:	480-897-7044
Fax Number	:	480-897-7943

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ZACK RAGSDALE
Credential	:
Telephone Number	:	512-454-5911

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	09/23/2024

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