Basic Information
| Provider Information | |||||||||
| NPI: | 1528009248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODLANDS BEHAVIORAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5850 GRANITE PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750246748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724640022 | ||||||||
| FaxNumber: | 9724640021 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | WINNFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714832650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186285445 | ||||||||
| FaxNumber: | 3186285515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | ARCHER | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9724640022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 559 | LA | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1709557 | 05 | LA | MEDICAID |