Provider Demographics
NPI:1972385672
Name:BEHAVIORAL HEALTH PORTER VILLAGE, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH PORTER VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:F
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-0022
Mailing Address - Street 1:3905 HEDGCOXE RD UNIT 250249
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0840
Mailing Address - Country:US
Mailing Address - Phone:972-464-0022
Mailing Address - Fax:
Practice Address - Street 1:506 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-754-1309
Practice Address - Fax:405-753-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital