Healthcare Provider Details

I. General information

NPI: 1821241712
Provider Name (Legal Business Name): MELBROOK COMMUNITY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 MELBROOK DR
GRETNA LA
70056-7715
US

IV. Provider business mailing address

PO BOX 6987
NEW ORLEANS LA
70174-6987
US

V. Phone/Fax

Practice location:
  • Phone: 504-366-1828
  • Fax: 504-366-1867
Mailing address:
  • Phone: 504-366-1828
  • Fax: 504-366-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN MCILWAIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 504-366-1828