Basic Information
| Provider Information | |||||||||
| NPI: | 1689897282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEANS BEHAVIORAL HOSPITAL OF KENTWOOD, L.L.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OCEANS BEHAVIORAL HOSPITAL OF KENTWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3905 HEDGCOXE RD UNIT 250249 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750250840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724640022 | ||||||||
| FaxNumber: | 9724640021 | ||||||||
| Practice Location | |||||||||
| Address1: | 15782 PROFESSIONAL PLZ | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704031451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852771415 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARCHER | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 9724640022 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 04709722 | 05 | MS | MEDICAID | 1702153 | 05 | LA | MEDICAID |