Basic Information
| Provider Information | |||||||||
| NPI: | 1740737535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOYALTY BEHAVIORAL HEALTHCARE CENTER , LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110A W HIRAM ST | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755512510 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 110A W HIRAM ST | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755512510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185720360 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | BUTLER | ||||||||
| AuthorizedOfficialFirstName: | FELECIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3185720360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 783264 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.