Healthcare Provider Details

I. General information

NPI: 1770537607
Provider Name (Legal Business Name): PREEMINENT HEALTHCARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 N BERTRAND DR
LAFAYETTE LA
70506-2130
US

IV. Provider business mailing address

325 N AVENUE F
CROWLEY LA
70526-5042
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-0700
  • Fax: 337-593-0799
Mailing address:
  • Phone: 337-783-5262
  • Fax: 337-783-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9563
License Number StateLA

VIII. Authorized Official

Name: BRANDY MALLET
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-783-5262