MEDICARE: PROJECT RECONSTRUCTION

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1750771663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT RECONSTRUCTION

Provider Business Mailing Address
First Line	:	2651 POYDRAS ST
Second Line	:	SUITE 2411
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 POYDRAS ST
Second Line	:	SUITE 2411
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7579
Country	:	US
Telephone Number	:	504-300-5883
Fax Number	:

Authorized Official
Title or Position	:	BOARD PRESIDENT
Name	:	NICOLE COUSIN
Credential	:
Telephone Number	:	504-300-5883

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	01/29/2015

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Directions to “PROJECT RECONSTRUCTION ” Practice Location

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