1548224330 NPI number — DEPT. OF HEALTH & HOSPITALS

Table of content: (NPI 1548224330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548224330 NPI number — DEPT. OF HEALTH & HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPT. OF HEALTH & HOSPITALS
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:
1548224330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71306-0118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-484-6400
Provider Business Mailing Address Fax Number:
318-487-5703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEADOW LANE
Provider Second Line Business Practice Location Address:
C/O CENTRAL STATE HOSPITAL, UNIT 6,
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-484-6400
Provider Business Practice Location Address Fax Number:
318-487-5703
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANNELLA
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
INPATIENT FACILITY MANAGER
Authorized Official Telephone Number:
318-484-6661

Provider Taxonomy Codes

  • Taxonomy code: 276400000X , with the licence number:  162 , 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: F0545 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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