Healthcare Provider Details

I. General information

NPI: 1962520213
Provider Name (Legal Business Name): SOUTHEAST LOUISIANA AREA HEALTH EDUCATION FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 J W DAVIS DR
HAMMOND LA
70403-5914
US

IV. Provider business mailing address

1302 J W DAVIS DR
HAMMOND LA
70403-5914
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-1119
  • Fax:
Mailing address:
  • Phone: 985-345-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberCM 1414
License Number StateLA

VIII. Authorized Official

Name: MR. BRIAN P JAKES SR.
Title or Position: CHEIF EXECUTIVE OFFICER
Credential: BFA
Phone: 985-345-1119