Provider Demographics
NPI:1891193868
Name:OCEANS BEHAVIORAL HOSPITAL OF KATY LLC
Entity type:Organization
Organization Name:OCEANS BEHAVIORAL HOSPITAL OF KATY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-0022
Mailing Address - Street 1:3905 HEDGCOXE RD UNIT 250249
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0840
Mailing Address - Country:US
Mailing Address - Phone:972-464-0022
Mailing Address - Fax:972-464-0021
Practice Address - Street 1:455 PARK GROVE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1572
Practice Address - Country:US
Practice Address - Phone:281-492-8888
Practice Address - Fax:281-492-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100289283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100289OtherHOSPITAL LICENSE
TX3520751-01Medicaid
TX100289OtherHOSPITAL LICENSE