Provider Demographics
NPI:1063056059
Name:COMPASS BEHAVIORAL CENTER OF ALEXANDRIA, LLC
Entity type:Organization
Organization Name:COMPASS BEHAVIORAL CENTER OF ALEXANDRIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-785-8003
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-0428
Mailing Address - Country:US
Mailing Address - Phone:337-785-8003
Mailing Address - Fax:337-785-8045
Practice Address - Street 1:137 DR CHILDRESS DR
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-0100
Practice Address - Country:US
Practice Address - Phone:337-758-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS BEHAVIORAL CENTER OF ALEXANDRIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-01
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1128660Medicaid