1104180884 NPI number — A LIFE CHOICE FOR PERSONAL ENHANCEMENT, LLC

Table of content: (NPI 1104180884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104180884 NPI number — A LIFE CHOICE FOR PERSONAL ENHANCEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A LIFE CHOICE FOR PERSONAL ENHANCEMENT, 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:
1104180884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 WHITNEY AVE
Provider Second Line Business Mailing Address:
604
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-362-0504
Provider Business Mailing Address Fax Number:
504-362-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 WHITNEY AVE
Provider Second Line Business Practice Location Address:
604
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-2558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-362-0504
Provider Business Practice Location Address Fax Number:
504-362-0504
Provider Enumeration Date:
06/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARSHALL-FERGUSON
Authorized Official First Name:
TRICIA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
504-362-0504

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4671998 , 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: 03 . This is a "HUMANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 04 . This is a "MHNET/BEHAVIORAL HEALTH" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 06 . This is a "HMO OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 13 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 02 . This is a "COMPCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 07 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 08 . This is a "VALUE OPTIONS INC" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 4000 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05 . This is a "MHNET SPECIALTY SERVICES" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 10 . This is a "APWU HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 11 . This is a "LIFESYNCH" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 001 . This is a "BCBS OF LOUISIANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007792856 . This is a "AETNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 09 . This is a "MILITARY ONESOURCE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 12 . This is a "GEVERNMENT EMPLOYEES HEALTH ASSOCIATION INC." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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