Basic Information
Provider Information | |||||||||
NPI: | 1851341432 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OCEANS BEHAVIORAL HOSPITAL OF LAFAYETTE LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OCEANS HOSPITAL OF BROUSSARD | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3905 HEDGCOXE RD UNIT 250249 | ||||||||
Address2: |   | ||||||||
City: | PLANO | ||||||||
State: | TX | ||||||||
PostalCode: | 750250840 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9724640022 | ||||||||
FaxNumber: | 3377211976 | ||||||||
Practice Location | |||||||||
Address1: | 418 ALBERTSON PARKWAY | ||||||||
Address2: |   | ||||||||
City: | BROUSSARD | ||||||||
State: | LA | ||||||||
PostalCode: | 70518 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3372376444 | ||||||||
FaxNumber: | 3372376445 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/12/2006 | ||||||||
LastUpdateDate: | 01/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TARANTINO | ||||||||
AuthorizedOfficialFirstName: | LAURA | ||||||||
AuthorizedOfficialMiddleName: | F. | ||||||||
AuthorizedOfficialTitleorPosition: | EVP/CORP. COUNSEL | ||||||||
AuthorizedOfficialTelephone: | 9724640022 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/30/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 548 | LA | Y |   | Hospitals | Psychiatric Hospital |   |
No ID Information.