MEDICARE: EASTERN LA. MENTAL HEALTH SYS

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	283Q00000X	Psychiatric Hospital	201	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	:	1700094471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN LA. MENTAL HEALTH SYS

Provider Business Mailing Address
First Line	:	23260 GREENWELL SPRINGS RD
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-6031
Country	:	US
Telephone Number	:	225-262-2441
Fax Number	:	225-262-2435

Provider Business Practice Location Address
First Line	:	23260 GREENWELL SPRINGS RD
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-6031
Country	:	US
Telephone Number	:	225-262-2441
Fax Number	:	225-262-2435

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARK ANDERS
Credential	:	CEO
Telephone Number	:	225-634-0201

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/08/2008

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