1588006886 NPI number — PEOPLE UNITED OF LOUISIANA LLC

Table of content: (NPI 1588006886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588006886 NPI number — PEOPLE UNITED OF LOUISIANA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEOPLE UNITED OF LOUISIANA 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:
1588006886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77053
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70879-7053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-756-4494
Provider Business Mailing Address Fax Number:
225-756-4495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 JACKSON ST EXT STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-756-4494
Provider Business Practice Location Address Fax Number:
225-756-4495
Provider Enumeration Date:
07/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROACH
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-756-4494

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302F00000X , with the licence number: 2203781706 , 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)





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