Healthcare Provider Details

I. General information

NPI: 1619318862
Provider Name (Legal Business Name): CHOICES OF LOUISIANA, ALEXANDRIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 N BOLTON AVE
ALEXANDRIA LA
71303-4405
US

IV. Provider business mailing address

PO BOX 310
BRITTANY LA
70718-0310
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-1216
  • Fax:
Mailing address:
  • Phone: 225-450-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberSA0003769
License Number StateLA

VIII. Authorized Official

Name: MRS. ELSIE JOAN BROWN
Title or Position: PRESIDENT/OWNER
Credential: LPN,LAC,CRT
Phone: 225-450-3340