Provider Demographics
NPI:1225285554
Name:RENEWING BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:RENEWING BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:LEDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-306-2482
Mailing Address - Street 1:409 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-2652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 N 13TH ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2742
Practice Address - Country:US
Practice Address - Phone:318-306-2482
Practice Address - Fax:313-335-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)