Basic Information
| Provider Information | |||||||||
| NPI: | 1326078023 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAUREL OAKS BEHAVIORAL HEALTH CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RAMSAY YOUTH SERVICES | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E COTTONWOOD RD | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363013644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347947373 | ||||||||
| FaxNumber: | 3347024530 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E COTTONWOOD RD | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363013644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347947373 | ||||||||
| FaxNumber: | 3347024530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FILTON | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VP CFO | ||||||||
| AuthorizedOfficialTelephone: | 6107683300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | AL | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 283Q00000X | 11812 | AL | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 011-848 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 129578 | 01 | VALUEOPTIONS | OTHER | PSY4007H | 05 | AL | MEDICAID | RTF0002H | 05 | AL | MEDICAID | 010-015 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |