MEDICARE: BHG LVIII, 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	261QM2800X	Methadone Clinic
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1568230696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHG LVIII, 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	:	1024 IVAL JAMES BLVD
Second Line	:	SUITE C, OBOT ROOM 100
City	:	RICHMOND
State	:	KY
Zip	:	40475-7622
Country	:	US
Telephone Number	:	859-575-1323
Fax Number	:	859-575-1325

Authorized Official
Title or Position	:	CEO
Name	:	JAY HIGHAM
Credential	:
Telephone Number	:	214-365-6112

Provider Enumeration Date	:	12/18/2023
Last Update Date	:	12/18/2023

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