Healthcare Provider Details

I. General information

NPI: 1346453669
Provider Name (Legal Business Name): INTERLINK HEALTH CARE HOME AND COMMUNITY BASED WAIVER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 DOMINICAN DRIVE, STE. 201
LAPLACE LA
70068
US

IV. Provider business mailing address

3525 PRYTANIA ST STE 608
NEW ORLEANS LA
70115-8106
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-1847
  • Fax: 985-652-1809
Mailing address:
  • Phone: 504-891-8100
  • Fax: 504-891-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberPCA 7065
License Number StateLA

VIII. Authorized Official

Name: MS. PAIGEDENE ANN EAGLIN
Title or Position: CEO
Credential:
Phone: 225-342-0138