Healthcare Provider Details

I. General information

NPI: 1114303534
Provider Name (Legal Business Name): DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 FLORIDA AVE SUITE A
KENNER LA
70065-3680
US

IV. Provider business mailing address

PO BOX 4148
NEW ORLEANS LA
70178-4148
US

V. Phone/Fax

Practice location:
  • Phone: 504-468-4437
  • Fax: 504-471-4782
Mailing address:
  • Phone: 504-207-3060
  • Fax: 504-483-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRIFFIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 504-212-9502