Provider Demographics
NPI:1164518312
Name:OCEANS BEHAVIORAL HOSPITAL OF LAFAYETTE LLC
Entity Type:Organization
Organization Name:OCEANS BEHAVIORAL HOSPITAL OF LAFAYETTE LLC
Other - Org Name:OCEANS HOSPITAL OF BROUSSARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-0022
Mailing Address - Street 1:3905 HEDGCOXE RD UNIT 250249
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0840
Mailing Address - Country:US
Mailing Address - Phone:972-464-0022
Mailing Address - Fax:972-464-0021
Practice Address - Street 1:420 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4968
Practice Address - Country:US
Practice Address - Phone:337-237-6444
Practice Address - Fax:337-839-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA548283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1704717Medicaid
LA194073Medicare Oscar/Certification