1013204312 NPI number — MQVN COMMUNITY DEVELOPMENT CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013204312 NPI number — MQVN COMMUNITY DEVELOPMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MQVN COMMUNITY DEVELOPMENT CORPORATION
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:
Provider Other Organization Name Type Code:
6
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:
1013204312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4626 ALCEE FORTIER BOULEVARD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70129-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-255-9170
Provider Business Mailing Address Fax Number:
504-255-9190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46S6 ALCEE FORTIER BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70129-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-255-8665
Provider Business Practice Location Address Fax Number:
504-234-8664
Provider Enumeration Date:
07/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
DIEM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
504-255-9170

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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