Basic Information
Provider Information
NPI: 1750620456
EntityType: 2
ReplacementNPI:  
OrganizationName: OCEANS BEHAVIORAL HOSPITAL OF ABILENE, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: OCEANS BEHAVIORAL HOSPITAL OF ABILENE
OtherOrganizationType: 3
OtherLastName:  
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OtherCredential:  
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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: 4225 WOODS PL
Address2:  
City: ABILENE
State: TX
PostalCode: 796027991
CountryCode: US
TelephoneNumber: 3256910030
FaxNumber: 3377211976
Other Information
ProviderEnumerationDate: 01/31/2013
LastUpdateDate: 09/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ARCHER
AuthorizedOfficialFirstName: STUART
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 9724640022
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
283Q00000X100212TXY HospitalsPsychiatric Hospital 

No ID Information.


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