Healthcare Provider Details

I. General information

NPI: 1033167762
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH & HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

23664 CARDINAL COVE
MANDEVILLE LA
70448
US

IV. Provider business mailing address

PO BOX 1225
MANDEVILLE LA
70470-1225
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-4121
  • Fax: 985-624-4123
Mailing address:
  • Phone: 985-624-4121
  • Fax: 985-624-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number32
License Number StateLA

VIII. Authorized Official

Name: MR. DAN BOUDREAUX
Title or Position: DIRECTOR
Credential:
Phone: 985-624-4100