Healthcare Provider Details

I. General information

NPI: 1659636561
Provider Name (Legal Business Name): EKHAYA YOUTH PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 5TH ST
GRETNA LA
70053-6008
US

IV. Provider business mailing address

1112 5TH ST
GRETNA LA
70053-6008
US

V. Phone/Fax

Practice location:
  • Phone: 504-858-4673
  • Fax: 855-662-4366
Mailing address:
  • Phone: 504-267-0470
  • Fax: 855-662-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. DARRIN LEON HARRIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 504-858-4673