Basic Information
| Provider Information | |||||||||
| NPI: | 1356080485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHG LVIII, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 SPRING VALLEY ROAD | ||||||||
| Address2: | SUITE 600 EAST | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752448217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143656100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 628 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | PAINTSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412401471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067896966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2022 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | HIGHAM | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2143656112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.