Healthcare Provider Details

I. General information

NPI: 1104871425
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 AVENUE H
LAKE CHARLES LA
70615-5186
US

IV. Provider business mailing address

4012 AVENUE H
LAKE CHARLES LA
70615-5186
US

V. Phone/Fax

Practice location:
  • Phone: 337-491-2355
  • Fax: 337-491-2492
Mailing address:
  • Phone: 337-491-2355
  • Fax: 337-491-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number044
License Number StateLA

VIII. Authorized Official

Name: MS. JEMECE MICHELLE RICHARD
Title or Position: INPATIENT MANAGER
Credential: LAC
Phone: 337-491-2355