Provider Demographics
NPI:1134838857
Name:BHG LXII LLC
Entity type:Organization
Organization Name:BHG LXII LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-365-6112
Mailing Address - Street 1:5001 SPRING VALLEY ROAD
Mailing Address - Street 2:SUITE 600 EAST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3946
Mailing Address - Country:US
Mailing Address - Phone:214-365-6100
Mailing Address - Fax:214-365-6150
Practice Address - Street 1:1303 LINE AVE STE 600
Practice Address - Street 2:OBOT ROOM # 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4638
Practice Address - Country:US
Practice Address - Phone:318-425-3400
Practice Address - Fax:318-425-3447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BHG LXII LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-21
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)