Provider Demographics
NPI:1336232396
Name:RUSTON NEUROPSYCHIATRIC HOSPITAL
Entity Type:Organization
Organization Name:RUSTON NEUROPSYCHIATRIC HOSPITAL
Other - Org Name:HEALTH PARADIGM HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-251-2322
Mailing Address - Street 1:146 SHAMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1012
Mailing Address - Country:US
Mailing Address - Phone:318-254-0142
Mailing Address - Fax:318-254-2829
Practice Address - Street 1:146 SHAMAN RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5347
Practice Address - Country:US
Practice Address - Phone:318-254-0142
Practice Address - Fax:318-254-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA565283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1709573Medicaid
LA1709573Medicaid