1871890871 NPI number — GENESIS YOUTH AND FAMILY SERVICES OF LA, LLC

Table of content: (NPI 1871890871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871890871 NPI number — GENESIS YOUTH AND FAMILY SERVICES OF LA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS YOUTH AND FAMILY SERVICES OF LA, LLC
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:
1871890871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42915
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28215-0017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-932-0200
Provider Business Mailing Address Fax Number:
225-932-0201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 FLORIDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-4274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-932-0200
Provider Business Practice Location Address Fax Number:
225-932-0201
Provider Enumeration Date:
02/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-253-3752

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)





Copyright © 2007-2024 www.npivalidator.com