1437283389 NPI number — E D & J GROUP HOME

Table of content: (NPI 1437283389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437283389 NPI number — E D & J GROUP HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E D & J GROUP HOME
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:
1437283389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 657
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIOLET
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-272-0269
Provider Business Mailing Address Fax Number:
504-272-0271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 ST CLAUDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-272-0269
Provider Business Practice Location Address Fax Number:
504-272-0271
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
BYKEN
Authorized Official Middle Name:
GENEVA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
504-272-0269

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: PROVIDER#1476871 , 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: 1476871 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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