Provider Demographics
NPI:1396285581
Name:CENTER FOR INTEGRATED BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:CENTER FOR INTEGRATED BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-933-9000
Mailing Address - Street 1:10473 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8264
Mailing Address - Country:US
Mailing Address - Phone:225-924-1910
Mailing Address - Fax:225-924-1988
Practice Address - Street 1:10473 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8264
Practice Address - Country:US
Practice Address - Phone:225-924-1910
Practice Address - Fax:225-924-1988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODLAKE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty