Provider Demographics
NPI:1346410172
Name:PHOENIX BEHAVIORAL HOSPITAL OF EUNICE, LLC
Entity Type:Organization
Organization Name:PHOENIX BEHAVIORAL HOSPITAL OF EUNICE, LLC
Other - Org Name:PHOENIX BEHAVIORAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-641-3717
Mailing Address - Street 1:4333 SHREVEPORT HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-445-6470
Mailing Address - Fax:318-641-3745
Practice Address - Street 1:2021 CROWLEY RAYNE HWY
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578
Practice Address - Country:US
Practice Address - Phone:337-788-0091
Practice Address - Fax:866-933-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA273Y00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1704491Medicaid
LA1704491Medicaid