MEDICARE: BEHAVIORAL HOSPITAL OF BELLAIRE, 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		TX

General Provider Information

NPI Number	:	1811060569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HOSPITAL OF BELLAIRE, LLC

Provider Business Mailing Address
First Line	:	2014 W PINHOOK RD
Second Line	:	SUITE 404
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-8504
Country	:	US
Telephone Number	:	337-264-8121
Fax Number	:	337-264-8194

Provider Business Practice Location Address
First Line	:	5314 DASHWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4603
Country	:	US
Telephone Number	:	713-600-9500
Fax Number	:	713-600-9548

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. MARK J HARRIS
Credential	:
Telephone Number	:	337-264-8121

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	04/10/2008

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