1578681359 NPI number — EASTER SEALS LOUISIANA INC.

Table of content: (NPI 1578681359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578681359 NPI number — EASTER SEALS LOUISIANA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS 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:
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:
1578681359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 COMMON STREET
Provider Second Line Business Mailing Address:
SUITE 2440
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-523-7325
Provider Business Mailing Address Fax Number:
504-523-3465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 LINE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 355
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-221-8244
Provider Business Practice Location Address Fax Number:
318-221-8726
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARNER
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
504-523-7325

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , 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)

  • Identifier: CM0006484 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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