Provider Demographics
NPI:1114178092
Name:EXODUS BEHAVIORAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:EXODUS BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:225-223-2235
Mailing Address - Street 1:118 HWY 605
Mailing Address - Street 2:
Mailing Address - City:NEWELLTON
Mailing Address - State:LA
Mailing Address - Zip Code:71357
Mailing Address - Country:US
Mailing Address - Phone:225-223-2235
Mailing Address - Fax:
Practice Address - Street 1:118 HWY 605
Practice Address - Street 2:
Practice Address - City:NEWELLTON
Practice Address - State:LA
Practice Address - Zip Code:71357
Practice Address - Country:US
Practice Address - Phone:225-223-2235
Practice Address - Fax:318-757-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health