Provider Demographics
NPI:1700031713
Name:BIENVILLE MEDICAL CENTER BEHAVORIAL HEALTH UNIT
Entity Type:Organization
Organization Name:BIENVILLE MEDICAL CENTER BEHAVORIAL HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:504 TEXAS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3526
Mailing Address - Country:US
Mailing Address - Phone:318-226-8202
Mailing Address - Fax:318-226-8205
Practice Address - Street 1:1175 PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3113
Practice Address - Country:US
Practice Address - Phone:318-263-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA552273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit