Healthcare Provider Details

I. General information

NPI: 1255737284
Provider Name (Legal Business Name): DDMS OF LOUISIANA NO 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 03/05/2023
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 GADSDEN ST
KENNER LA
70062-5034
US

IV. Provider business mailing address

313 CONGRESS ST
BOSTON MA
02210-1218
US

V. Phone/Fax

Practice location:
  • Phone: 504-712-1323
  • Fax:
Mailing address:
  • Phone: 800-388-5150
  • Fax: 617-790-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateLA

VIII. Authorized Official

Name: BRETT IAN COHEN
Title or Position: COO
Credential:
Phone: 800-388-5150