Provider Demographics
NPI:1548626203
Name:UNCONDITIONAL CARE BEHAVIORAL CENTER
Entity type:Organization
Organization Name:UNCONDITIONAL CARE BEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHASSITY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-573-0439
Mailing Address - Street 1:2924 KNIGHT ST
Mailing Address - Street 2:318
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2415
Mailing Address - Country:US
Mailing Address - Phone:318-216-5562
Mailing Address - Fax:318-635-8748
Practice Address - Street 1:2924 KNIGHT ST
Practice Address - Street 2:318
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-216-5562
Practice Address - Fax:318-635-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health