Behavioral Hospital of Longview, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

008387 Issued in TX

Legal business name

BEHAVIORAL HOSPITAL OF LONGVIEW, LLC

Practice address

22 Bermuda LN
Longview, TX 75605-2902

Phone

(903) 291-3456

NPI assigned

Jan 2, 2008

Last updated

Apr 9, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark J Harris

Title

Managing Member

Phone

(337) 264-8121

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487839023. Details of each certification follow.

• CCN 454105 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 454105

Legal name

BEHAVIORAL HOSPITAL OF LONGVIEW

Certification status

Terminated Voluntary: risk of involuntary termination, Jul 21, 2016

Provider type (POS)

Hospital – Psychiatric

Participating since

Jan 31, 2006

Last certification

May 18, 2016

Beds

76

Ownership / control type

Private (for profit)

Most recent change of ownership

Mar 19, 2010 (3 total)

Facility address

22 Bermuda Lane
Longview, TX 75605

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1487839023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2014 W PINHOOK RD",
            "address_2": "SUITE 610",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705088504",
            "telephone_number": "337-264-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BERMUDA LN",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052902",
            "telephone_number": "903-291-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HOSPITAL OF LONGVIEW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-264-8121",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "TX",
            "license": "008387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "454105",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffory W Beaty, DO
• Robert Wayne Beaudoin
• Eugene Rayshawn Beaver Jr., MS, LAT, ATC, CES
• Dennis Ray Beck, M.D.
• Laccie Lea Beck, RN
• Lisa Michelle Belknap, LPC
• Deborah K Bell, NP
• Erica Bell, MS. RD. LD
• Erik Morolo Bell, P.T.
• Joseph W. Bell, MD

• Psychiatric Hospital in Longview, TX
• Providers in Longview, TX by specialty
• Psychiatric Hospital in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.