MEDICARE: MESA SPRINGS, 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
1	283Q00000X	Psychiatric Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366880627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA SPRINGS, LLC

Provider Business Mailing Address
First Line	:	4801 OLYMPIA PARK PLZ STE 1000
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2090
Country	:	US
Telephone Number	:	502-916-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	5560 MESA SPRINGS DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123
Country	:	US
Telephone Number	:	817-292-4600
Fax Number	:	817-292-4604

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHARLOTTE LAWRENCE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	05/04/2023

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