Provider Demographics
NPI:1427122969
Name:PHC-OPELOUSAS LP
Entity type:Organization
Organization Name:PHC-OPELOUSAS LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:103 POWELL CT
Mailing Address - Street 2:STE. 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5079
Mailing Address - Country:US
Mailing Address - Phone:615-372-8500
Mailing Address - Fax:615-372-8572
Practice Address - Street 1:225 GUIDROZ
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512
Practice Address - Country:US
Practice Address - Phone:318-754-5557
Practice Address - Fax:318-754-5552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHC-OPELOUSAS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA417-A273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705829Medicaid
LA19S191Medicare Oscar/Certification