1821421686 NPI number — NORTHWEST LOUISIANA HUMAN SERVICES DISTRICT

Table of content: (NPI 1821421686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821421686 NPI number — NORTHWEST LOUISIANA HUMAN SERVICES DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST LOUISIANA HUMAN SERVICES DISTRICT
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:
1821421686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 N HEARNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71107-6516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-676-5111
Provider Business Mailing Address Fax Number:
318-676-5021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 N HEARNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71107-6516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-676-5111
Provider Business Practice Location Address Fax Number:
318-676-5021
Provider Enumeration Date:
08/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
ACCOUNTING SUPERVISOR
Authorized Official Telephone Number:
318-862-3067

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  2203782546 , 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: 2203782546 . This is a "BEHAVIORAL HEALTH SERVICE PROVIDER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1710083 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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