Basic Information
| Provider Information | |||||||||
| NPI: | 1700031713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIENVILLE MEDICAL CENTER BEHAVORIAL HEALTH UNIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 TEXAS ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182268202 | ||||||||
| FaxNumber: | 3182268205 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 PINE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710013113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182634700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | MERK | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3182268202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 552 | LA | Y | Hospital Units | Psychiatric Unit |
No ID Information.