Provider Demographics
NPI:1932251683
Name:THREE OAKS BEHAVIORAL HEALTH OF RIDGELAND, LLC
Entity Type:Organization
Organization Name:THREE OAKS BEHAVIORAL HEALTH OF RIDGELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-991-3080
Mailing Address - Street 1:408 FONTAINE PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5145
Mailing Address - Country:US
Mailing Address - Phone:601-991-3080
Mailing Address - Fax:601-991-0923
Practice Address - Street 1:408 FONTAINE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5145
Practice Address - Country:US
Practice Address - Phone:601-991-3080
Practice Address - Fax:601-991-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDCS TOBHR PHA OP 01283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital