1588750533 NPI number — DEPARTMENT OF HEALTH AND HOSPITALS

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 1588750533 NPI number — DEPARTMENT OF HEALTH AND HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF HEALTH AND HOSPITALS
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:
1588750533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 SOUTH COURT ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLE PLATTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-363-5525
Provider Business Mailing Address Fax Number:
337-363-1567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VILLE PLATTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70586-5248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-363-5525
Provider Business Practice Location Address Fax Number:
337-363-1567
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOURQUE
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
MENTAL HEALTH CENTER MANAGER
Authorized Official Telephone Number:
337-363-5526

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  111 , 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: 1710296 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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