1841437498 NPI number — STRATEGIC ALLIANCES OF LOUISIANA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841437498 NPI number — STRATEGIC ALLIANCES OF LOUISIANA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATEGIC ALLIANCES 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:
1841437498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14241 COURSEY BLVD
Provider Second Line Business Mailing Address:
STE A12167
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70817-1368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-223-3652
Provider Business Mailing Address Fax Number:
225-272-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3975 ONEAL LN STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-9092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-223-3652
Provider Business Practice Location Address Fax Number:
225-272-2534
Provider Enumeration Date:
01/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROACH
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
225-223-3652

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  27049 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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