Provider Demographics
NPI:1346775210
Name:APPLEGATE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:APPLEGATE HEALTH SERVICES INC
Other - Org Name:APPLEGATE RECOVERY OF LAKE CHARLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:348-742-0500
Mailing Address - Street 1:3303 CENTRAL EXPY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-6913
Mailing Address - Country:US
Mailing Address - Phone:972-578-2333
Mailing Address - Fax:972-578-2444
Practice Address - Street 1:617 W PRIEN LAKE RD
Practice Address - Street 2:SUITE L
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8386
Practice Address - Country:US
Practice Address - Phone:337-540-7184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0700X
LA00000261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment