1982164224 NPI number — CLHG-LEESVILLE

Table of content: (NPI 1982164224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982164224 NPI number — CLHG-LEESVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLHG-LEESVILLE
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:
1982164224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 W FERTITTA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-4645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-239-5274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18570 JOHNNY B. HALL MEMORIAL HWY
Provider Second Line Business Practice Location Address:
U.S. ROUTE 171
Provider Business Practice Location Address City Name:
ROSEPINE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-462-1913
Provider Business Practice Location Address Fax Number:
337-462-1898
Provider Enumeration Date:
03/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CAMERON
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
318-226-8202

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com