Provider Demographics
NPI:1104299676
Name:AF BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:AF BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WISE-GASTINELL
Authorized Official - Suffix:
Authorized Official - Credentials:ADD
Authorized Official - Phone:504-393-0407
Mailing Address - Street 1:6400 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-2020
Mailing Address - Country:US
Mailing Address - Phone:504-393-0407
Mailing Address - Fax:866-653-7509
Practice Address - Street 1:6400 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-2020
Practice Address - Country:US
Practice Address - Phone:504-393-0407
Practice Address - Fax:866-653-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization