Beacon Behavioral Hospital Northshore, LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

BEACON BEHAVIORAL HOSPITAL NORTHSHORE, LLC

Practice address

64026 Highway 434 Ste 300
Lacombe, LA 70445-5417

Phone

(985) 882-0226

Fax

(985) 882-9853

NPI assigned

May 17, 2006

Last updated

Nov 13, 2023By 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. Phillip Sean Wendell

Title

Ceo

Phone

(225) 810-4040

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508819202. Details of each certification follow.

• CCN 194080 Hospital · Active · Details

Hospital certification: CCN 194080

Legal name

BEACON BEHAVIORAL HOSPITAL NORTHSHORE, LLC

Certification status

Active

Provider type (POS)

Hospital – Psychiatric

Participating since

Nov 17, 2005

Last certification

Aug 8, 2024

Beds

22

Ownership / control type

Private (for profit)

Most recent change of ownership

Apr 12, 2015 (2 total)

Organization structure

LLCProprietary

Incorporated

Dec 4, 2020 in LA

Enrollment address

64026 Highway 434
Ste 300
Lacombe, LA 70445-5417
Other Hospital Practice Location

Hospital subgroups

Psychiatric

Listed as

Beacon Behavioral Hospital - Northshore, LLCCCN 194080 · All quality measures

Type

Psychiatric

Ownership

Proprietary

Medicare certification status

ActiveFrom the Provider of Services file

Emergency services

No

Tax ID family

Beacon Behavioral Hospital Northshore3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Beacon Behavioral Hospital Northshore

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Lacombe, LA
  • NPI 1083296156
  NPD tax ID
• Beacon Behavioral Hospital Northshore, LLC

  dba Beacon Behavioral Outpatient - Bogalusa

  • Mental Health Counselor
  • Bogalusa, LA
  • NPI 1558994434
  NPD tax ID

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Beacon Behavioral Hospital - New Orleans LLC

  • Psychiatric Hospital
  • New Orleans, LA
  • NPI 1760437131

  Beacon Hospital Management, LLC

  CMS ownership
• Beacon Behavioral Hospital LLC

  dba Beacon Behavioral Outpatient - Lutcher

  • Psychiatric Hospital
  • Lutcher, LA
  • NPI 1881996940

  Beacon Hospital Management, LLC

  CMS ownership
• Springlake Behavioral Health Bunkie LLC

  • Psychiatric Hospital
  • Bunkie, LA
  • NPI 1184044430

  Beacon Hospital Management, LLC

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Hyon Su Kim, M.D.

  • Psychiatry Physician
  • Mandeville, LA
  • NPI 1700079274
  NPD (past)
• Jose Mario Rodriguez, M.D.

  • Psychiatry Physician
  • Metairie, LA
  • NPI 1235399262
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1508819202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14707 PERKINS RD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708102216",
            "telephone_number": "225-810-4040",
            "fax_number": "225-810-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64026 HIGHWAY 434 STE 300",
            "city": "LACOMBE",
            "state": "LA",
            "postal_code": "704455417",
            "telephone_number": "985-882-0226",
            "fax_number": "985-882-9853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1640 S Columbia St Ste B",
            "address_purpose": "LOCATION",
            "city": "Bogalusa",
            "state": "LA",
            "postal_code": "704275800",
            "country_code": "US",
            "telephone_number": "985-735-1750",
            "fax_number": "985-735-1752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON BEHAVIORAL HOSPITAL NORTHSHORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "WENDELL",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-810-4040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08036043",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1709549",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Renee Barrosse
• Bayou Lacombe Dental Care LLC
• Bayou Wellness Center Inc
• Bayou Wellness Center, Inc.
• Beacon Behavioral Hospital Northshore
• Michael J Becker, MD
• Thomas Joel Berry, M.D.
• Bio-Medical Applications of Louisiana LLC (Fresenius Medical Care Lacombe)
• Blended Roots Wellness and Consulting
• Allie Elizabeth Blestel, MS, RD, LDN

• Psychiatric Hospital in Lacombe, LA
• Providers in Lacombe, LA by specialty
• Psychiatric Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.