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NPI Code Detail

MEDICARE: BHG LVI, LLC

MEDICARE: BHG LVI, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
3261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1700419074
Entity Type Code : Organization
Provider Name (Legal Business Name) : BHG LVI, LLC
Provider Business Mailing Address
First Line : 5001 SPRING VALLEY RD STE 600E
Second Line :
City : DALLAS
State : TX
Zip : 75244-8217
Country : US
Telephone Number : 214-365-6100
Fax Number : 214-365-6150
Provider Business Practice Location Address
First Line : 985 PLAINFIELD ST
Second Line :
City : JOHNSTON
State : RI
Zip : 02919-6703
Country : US
Telephone Number : 401-946-0650
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF LICENSING
Name : MRS. JEMECE MICHELLE GASAWAY
Credential : MSW, LMSW
Telephone Number : 214-365-6126
Provider Enumeration Date : 02/14/2020
Last Update Date : 02/14/2020

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