Provider Demographics
NPI:1629027602
Name:LIFECARE PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:LIFECARE PSYCHIATRIC SERVICES, LLC
Other - Org Name:ST. LANDRY PSYCHIATRIC TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-593-0108
Mailing Address - Street 1:201 RUE BEAUREGARD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3251
Mailing Address - Country:US
Mailing Address - Phone:337-593-0108
Mailing Address - Fax:337-593-9579
Practice Address - Street 1:216 ROBIN LN
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-9149
Practice Address - Country:US
Practice Address - Phone:337-948-5055
Practice Address - Fax:337-942-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60659OtherBCBS OF LA
LA194678Medicare ID - Type UnspecifiedCOMMUNITY MENTAL HEALTH C