Basic Information
| Provider Information | |||||||||
| NPI: | 1962916544 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMISE BEHAVIORAL HEALTH HOSPITAL OF SHREVEPORT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1206 AMIENS DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708104605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252813076 | ||||||||
| FaxNumber: | 2253108122 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 IRVING PL FL 3 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184254096 | ||||||||
| FaxNumber: | 3184242627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2017 | ||||||||
| LastUpdateDate: | 11/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | MCWILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | MAGGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGULATORY SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2252813076 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | Y | Hospitals | Special Hospital |
No ID Information.