1821241712 NPI number — MELBROOK COMMUNITY HOME

Table of content: (NPI 1821241712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821241712 NPI number — MELBROOK COMMUNITY HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELBROOK COMMUNITY 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:
1821241712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70174-6987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-366-1828
Provider Business Mailing Address Fax Number:
504-366-1867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 MELBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-366-1828
Provider Business Practice Location Address Fax Number:
504-366-1867
Provider Enumeration Date:
10/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCILWAIN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
504-366-1828

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1718289 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1719684 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1910074 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1918571 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1454257 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718378 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1719595 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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