NPIMap

Organization Active NPI

Peacock Addiction Treatment & Healing (Path) Center LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Rayville, LA
National Provider Identifier
1942033808
Registry record updated Aug 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PEACOCK ADDICTION TREATMENT & HEALING (PATH) CENTER LLC
Practice address
1401 Louisa St
Rayville, LA 71269-3245
Phone
(318) 303-4632
Fax
(318) 301-6826
NPI assigned
Aug 24, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2024

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

Authorized official

Name
Mrs. Jo Lynn Bennett, APRNNPI 1740687334
Title
Owner
Phone
(318) 334-5825

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X
Clinic/Center 261Q00000X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1401 Louisa St
Rayville, LA 71269-3245

Mailing address

437 Overlan Stage Rd
Rayville, LA 71269-7655
Phone (318) 334-5825

Other names 1

  • Peacock LifeCare Former legal business name

National Provider Directory

National Provider Directory

Locations

1401 Louisa St
Rayville, LA 71269
Phone (318) 303-4632

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1724457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724457600000",
    "number": "1942033808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 OVERLAN STAGE RD",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712697655",
            "telephone_number": "318-334-5825",
            "fax_number": "318-301-6826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 LOUISA ST",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712693245",
            "telephone_number": "318-303-4632",
            "fax_number": "318-301-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK ADDICTION TREATMENT & HEALING (PATH) CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-24",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JO",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-334-5825",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peacock LifeCare",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rayville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.