Healthcare Provider Details

I. General information

NPI: 1992039127
Provider Name (Legal Business Name): BONNABEL SBHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BRUIN DR.
KENNER LA
70065
US

IV. Provider business mailing address

8101 SIMON ST.
METAIRIE LA
70003
US

V. Phone/Fax

Practice location:
  • Phone: 504-303-6676
  • Fax: 504-303-6680
Mailing address:
  • Phone: 504-737-5523
  • Fax: 504-737-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. BELINDA B SCHOUEST
Title or Position: SECRETARY
Credential:
Phone: 504-737-5523