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NPI Code Detail

MEDICARE: LONG BRANCH RETREAT & RECOVERY CENTER LLC

MEDICARE: LONG BRANCH RETREAT & RECOVERY CENTER LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2273R00000XPsychiatric Hospital Unit
3276400000XSubstance Use Disorder Rehabilitation Hospital Unit
4323P00000XPsychiatric Residential Treatment Facility
5324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1245754894
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONG BRANCH RETREAT & RECOVERY CENTER LLC
Provider Business Mailing Address
First Line : 21516 HIGHWAY 36
Second Line :
City : ABITA SPRINGS
State : LA
Zip : 70420-3906
Country : US
Telephone Number : 504-267-9960
Fax Number : 504-267-9967
Provider Business Practice Location Address
First Line : 21516 HIGHWAY 36
Second Line :
City : ABITA SPRINGS
State : LA
Zip : 70420-3906
Country : US
Telephone Number : 504-214-4000
Fax Number : 504-265-8605
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : EMILY ELIZABETH MEYERS
Credential : LPC
Telephone Number : 920-309-0541
Provider Enumeration Date : 07/26/2017
Last Update Date : 12/23/2024

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