1396178885 NPI number — NORTHWEST LOUISIANA HUMAN SERVICES DISTRICT

Table of content: (NPI 1396178885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396178885 NPI number — NORTHWEST LOUISIANA HUMAN SERVICES DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST LOUISIANA HUMAN SERVICES DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHREVEPORT BEHAVIORAL HEALTH CLINIC - CHILDREN SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396178885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 N HEARNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71107-6516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-862-3067
Provider Business Mailing Address Fax Number:
318-862-3080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 N HEARNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71107-6516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-862-3067
Provider Business Practice Location Address Fax Number:
318-862-3080
Provider Enumeration Date:
08/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
318-862-3067

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  465 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: 2203781776 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com