Provider Demographics
NPI:1225388507
Name:COMPASS BEHAVIORAL CENTER OF ALEXANDRIA, LLC
Entity Type:Organization
Organization Name:COMPASS BEHAVIORAL CENTER OF ALEXANDRIA, LLC
Other - Org Name:ALEXANDRIA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JON
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-788-3330
Mailing Address - Street 1:6410 MASONIC DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2319
Mailing Address - Country:US
Mailing Address - Phone:318-473-0035
Mailing Address - Fax:318-443-0220
Practice Address - Street 1:6410 MASONIC DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-473-0035
Practice Address - Fax:318-443-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital