Healthcare Provider Details

I. General information

NPI: 1811440209
Provider Name (Legal Business Name): HOUSE OF JACOB HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 FILMORE ST
KENNER LA
70062-7810
US

IV. Provider business mailing address

316 FILMORE ST
KENNER LA
70062-7810
US

V. Phone/Fax

Practice location:
  • Phone: 504-305-0035
  • Fax: 504-305-0004
Mailing address:
  • Phone: 504-305-0035
  • Fax: 504-305-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTHER CLARISSE WANDA
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 504-251-8477