Provider Demographics
NPI:1043264351
Name:NESS HEALTHCARE NFP
Entity Type:Organization
Organization Name:NESS HEALTHCARE NFP
Other - Org Name:NORTHLAKE BEHAVIORAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-452-4565
Mailing Address - Street 1:23515 HWY 190
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:847-452-4585
Mailing Address - Fax:985-626-6559
Practice Address - Street 1:23515 HWY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:847-452-4585
Practice Address - Fax:985-626-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 2084P0802X
LA214283Q00000X
LA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2700111Medicaid
LA1710059Medicaid
LA1710059Medicaid