Provider Demographics
NPI:1871202598
Name:BHG LXII LLC
Entity type:Organization
Organization Name:BHG LXII LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING & CRED
Authorized Official - Prefix:
Authorized Official - First Name:ZACK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-5911
Mailing Address - Street 1:5001 SPRING VALLEY ROAD
Mailing Address - Street 2:SUITE 600 EAST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3946
Mailing Address - Country:US
Mailing Address - Phone:214-365-6100
Mailing Address - Fax:214-365-6150
Practice Address - Street 1:1910 RUFFIN DR
Practice Address - Street 2:OBOT ROOM #100
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-3616
Practice Address - Country:US
Practice Address - Phone:318-340-9596
Practice Address - Fax:318-340-9598
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BHG LXII LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone