1306800271 NPI number — FLORIDA PARISHES HUMAN SERVICES AUTHORITY / FONTAINEBLEAU TX CENTER

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 1306800271 NPI number — FLORIDA PARISHES HUMAN SERVICES AUTHORITY / FONTAINEBLEAU TX CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA PARISHES HUMAN SERVICES AUTHORITY / FONTAINEBLEAU TX CENTER
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:
1306800271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470-0037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-624-4100
Provider Business Mailing Address Fax Number:
985-624-4123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23861 ROBIN ROAD & HWY 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70447-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-624-4100
Provider Business Practice Location Address Fax Number:
985-624-4123
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
985-624-4100

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  240 , 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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