1033541230 NPI number — NORTHEAST DELTA HUMAN SERVICES AUTHORITY

Table of content: (NPI 1033541230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033541230 NPI number — NORTHEAST DELTA HUMAN SERVICES AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST DELTA HUMAN SERVICES AUTHORITY
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:
1033541230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 WHITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71270-5960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-251-4125
Provider Business Mailing Address Fax Number:
318-251-5000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 WHITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-5960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-251-4125
Provider Business Practice Location Address Fax Number:
318-251-5000
Provider Enumeration Date:
07/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
OCTAVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE PROGRAM SPECIALIST B
Authorized Official Telephone Number:
318-362-3270

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710342 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2203785977 . This is a "STATE LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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