Healthcare Provider Details

I. General information

NPI: 1689895575
Provider Name (Legal Business Name): HAMMOND DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42599 ROBINWOOD LN
HAMMOND LA
70403-3209
US

IV. Provider business mailing address

45439 LIVE OAK DRIVE
HAMMOND LA
70401-9420
US

V. Phone/Fax

Practice location:
  • Phone: 225-543-4191
  • Fax: 225-567-2017
Mailing address:
  • Phone: 225-567-3111
  • Fax: 225-567-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. KINDRED HODGE
Title or Position: DIRECTOR
Credential:
Phone: 225-567-3111