Provider Demographics
NPI:1407207863
Name:ALLEGIANCE HEALTH CENTER OF RUSTON LLC
Entity Type:Organization
Organization Name:ALLEGIANCE HEALTH CENTER OF RUSTON LLC
Other - Org Name:FREEDOM BEHAVIORAL HOSPITAL OF MONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:4402 STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2338
Mailing Address - Country:US
Mailing Address - Phone:318-966-4686
Mailing Address - Fax:
Practice Address - Street 1:4402 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2338
Practice Address - Country:US
Practice Address - Phone:318-255-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA599283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital