Provider Demographics
NPI:1972239705
Name:OCEANS BEHAVIORAL HOSPITAL OF TUPELO, LLC
Entity type:Organization
Organization Name:OCEANS BEHAVIORAL HOSPITAL OF TUPELO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-377-2219
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:504-645-8196
Mailing Address - Fax:972-464-0021
Practice Address - Street 1:4579 S EASON BLVD STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6539
Practice Address - Country:US
Practice Address - Phone:662-268-4418
Practice Address - Fax:662-224-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital