Provider Demographics
NPI:1245754894
Name:LONG BRANCH RETREAT & RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:LONG BRANCH RETREAT & RECOVERY CENTER LLC
Other - Org Name:LONGBRANCH RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-309-0541
Mailing Address - Street 1:21516 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3906
Mailing Address - Country:US
Mailing Address - Phone:504-267-9960
Mailing Address - Fax:504-267-9967
Practice Address - Street 1:21516 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3906
Practice Address - Country:US
Practice Address - Phone:504-214-4000
Practice Address - Fax:504-265-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No273R00000XHospital UnitsPsychiatric Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility