Provider Demographics
NPI:1376988907
Name:KAILO BEHAVIORAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:KAILO BEHAVIORAL HOSPITAL, LLC
Other - Org Name:KAILO BEHAVIORAL HOSPITAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-466-7600
Mailing Address - Street 1:3859 HIGHWAY 190
Mailing Address - Street 2:KAILO SUITE
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-7900
Mailing Address - Country:US
Mailing Address - Phone:337-466-7600
Mailing Address - Fax:337-466-7604
Practice Address - Street 1:3859 HIGHWAY 190
Practice Address - Street 2:KAILO SUITE
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-7900
Practice Address - Country:US
Practice Address - Phone:337-466-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit