Organization
BEACON BEHAVIORAL HOSPITAL NORTHSHORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP SEAN WENDELL (CEO)
(225) 810-4040
Entity
Organization
Contact information
Practice address
64026 HIGHWAY 434 STE 300, LACOMBE, LA 70445-5417
(985) 882-0226
(985) 882-9853
Mailing address
4601 BLUEBONNET BLVD STE B, BATON ROUGE, LA 70809-9656
(225) 810-4040
(225) 810-4050
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08036043
—
MS
05
—
1709549
—
LA
Enumeration date
04/27/2021
Last updated
04/27/2021
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