Provider Demographics
NPI:1528009248
Name:WOODLANDS BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:WOODLANDS BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-0022
Mailing Address - Street 1:5850 GRANITE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6748
Mailing Address - Country:US
Mailing Address - Phone:972-464-0022
Mailing Address - Fax:972-464-0021
Practice Address - Street 1:1400 W COURT ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2650
Practice Address - Country:US
Practice Address - Phone:318-628-5445
Practice Address - Fax:318-628-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA559283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1709557Medicaid
LA194076Medicare ID - Type UnspecifiedPROVIDER NUMBER