Provider Demographics
NPI:1881638880
Name:RED RIVER BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:RED RIVER BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTENBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-549-2033
Mailing Address - Street 1:2800 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5870
Mailing Address - Country:US
Mailing Address - Phone:318-549-2033
Mailing Address - Fax:318-549-3745
Practice Address - Street 1:2800 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-549-2033
Practice Address - Fax:318-549-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA572283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1709565Medicaid
LA1709565Medicaid