Provider Demographics
NPI:1356629166
Name:SHIFA BEHAVIORAL HEALTH,LLC
Entity Type:Organization
Organization Name:SHIFA BEHAVIORAL HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-7878
Mailing Address - Street 1:7916 WRENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1782
Mailing Address - Country:US
Mailing Address - Phone:225-927-7878
Mailing Address - Fax:225-927-7787
Practice Address - Street 1:515 GARDERE LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-7605
Practice Address - Country:US
Practice Address - Phone:225-927-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital