MEDICARE: SEASIDE HEALTH SYSTEM, 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	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
2	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720345663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASIDE HEALTH SYSTEM, LLC

Provider Business Mailing Address
First Line	:	4363 CONVENTION ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3906
Country	:	US
Telephone Number	:	225-522-4076
Fax Number	:

Provider Business Practice Location Address
First Line	:	4363 CONVENTION ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3906
Country	:	US
Telephone Number	:	225-522-4076
Fax Number	:	225-522-4076

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	CHRISTINA RYAN
Credential	:
Telephone Number	:	337-345-5110

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	05/07/2024

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Directions to “SEASIDE HEALTH SYSTEM, LLC ” Practice Location

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