| Northlake Behavioral Health System | |
|
23515 Hwy 190 Mandeville LA 70448 | |
| (847) 452-4585 | |
| (985) 626-6559 |
| Full Name | Northlake Behavioral Health System |
|---|---|
| Speciality | Psychiatric Hospital |
| Location | 23515 Hwy 190, Mandeville, Louisiana |
| Authorized Official Name and Position | Tony Shir (PRESIDENT) |
| Authorized Official Contact | 8474524565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northlake Behavioral Health System 23515 Hwy 190 Mandeville LA 70448 Ph: (847) 452-4585 | Northlake Behavioral Health System 23515 Hwy 190 Mandeville LA 70448 Ph: (847) 452-4585 |
| NPI Number | 1043264351 |
|---|---|
| Provider Enumeration Date | 05/20/2006 |
| Last Update Date | 04/06/2022 |
| Certification Date | 04/06/2022 |
| Medicare PECOS PAC ID | 2062795099 |
|---|---|
| Medicare Enrollment ID | O20170216001787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043264351 | NPI | - | NPPES |
| 2700111 | Medicaid | LA | |
| 1710059 | Medicaid | LA |
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