Healthcare Provider Details

I. General information

NPI: 1336379429
Provider Name (Legal Business Name): NORTH LAKE SUPPORTS AND SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45439 LIVE OAK DR
HAMMOND LA
70401-4526
US

IV. Provider business mailing address

45439 LIVE OAK DR
HAMMOND LA
70401-4526
US

V. Phone/Fax

Practice location:
  • Phone: 225-567-3111
  • Fax:
Mailing address:
  • Phone: 225-567-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HERMAN BIGNAR
Title or Position: MR/DD REGIONAL ADMINISTRATOR
Credential:
Phone: 225-567-3111