MEDICARE: BROOKHAVEN FAMILY SUPPORT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	10316	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073714598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKHAVEN FAMILY SUPPORT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 3133
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70059-3133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 HOLIDAY DR
Second Line	:	SUITE 308
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8202
Country	:	US
Telephone Number	:	504-362-6944
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VANESSA CARTER
Credential	:
Telephone Number	:	504-362-6944

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	09/04/2007

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