Provider Demographics
NPI:1326097429
Name:LIFECARE PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:LIFECARE PSYCHIATRIC SERVICES, LLC
Other - Org Name:LIFECARE PSYCHIATRIC TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:337-593-0108
Mailing Address - Street 1:201 RUE BEAUREGARD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3251
Mailing Address - Country:US
Mailing Address - Phone:337-593-0108
Mailing Address - Fax:338-590-9579
Practice Address - Street 1:170 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8309
Practice Address - Country:US
Practice Address - Phone:337-233-3880
Practice Address - Fax:337-262-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60659OtherBCBS OF LA
LA194674Medicare Oscar/Certification