MEDICARE: EASTERN LA. MENTAL HEALTH SYSTEM COMMUNITY HOMES DIVISION

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	703	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	:	1972729127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN LA. MENTAL HEALTH SYSTEM COMMUNITY HOMES DIVISION

Provider Business Mailing Address
First Line	:	PO BOX 498
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-0498
Country	:	US
Telephone Number	:	225-634-0661
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 HWY. 951
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-0498
Country	:	US
Telephone Number	:	225-634-0661
Fax Number	:

Authorized Official
Title or Position	:	ADM. CO. 4
Name	:	MS. DONNA M. HARRELL
Credential	:
Telephone Number	:	225-634-0661

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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