Provider Demographics
NPI:1528373347
Name:GRACE BEHAVIORAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:GRACE BEHAVIORAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TWILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-444-4352
Mailing Address - Street 1:2325 N HULLEN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-6915
Mailing Address - Country:US
Mailing Address - Phone:504-444-4352
Mailing Address - Fax:504-444-4352
Practice Address - Street 1:2325 N HULLEN ST STE 103
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6915
Practice Address - Country:US
Practice Address - Phone:504-444-4352
Practice Address - Fax:504-444-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health