1821318221 NPI number — BOOKER T COMMUNITY OUTREACH PROJECT

Table of content: (NPI 1821318221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821318221 NPI number — BOOKER T COMMUNITY OUTREACH PROJECT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOOKER T COMMUNITY OUTREACH PROJECT
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:
THE JOHN BREAUX ASSISTED LIVING CENTER
Provider Other Organization Name Type Code:
3
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:
1821318221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 SHERROUSE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71203-5435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-489-5900
Provider Business Mailing Address Fax Number:
318-934-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 SHERROUSE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-489-5300
Provider Business Practice Location Address Fax Number:
318-934-0097
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
318-489-5300

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com