1073904389 NPI number — NORMAL LIFE OF LOUISIANA, INC.

Table of content: NICOLA JEAN COLVIN RBT (NPI 1639529662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073904389 NPI number — NORMAL LIFE OF LOUISIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAL LIFE OF LOUISIANA, INC.
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:
1073904389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9901 LINN STATION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-394-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15460 TRACEY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70443-2470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-394-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OMBRES
Authorized Official First Name:
DEENA
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Authorized Official Telephone Number:
502-394-2100

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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