Healthcare Provider Details

I. General information

NPI: 1457032286
Provider Name (Legal Business Name): DDMS OF LOUISIANA NO 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 MEADOWDALE ST
METAIRIE LA
70006-4036
US

IV. Provider business mailing address

313 CONGRESS ST
BOSTON MA
02210-1218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: VICE PRES & SR. ASST GENERAL COUNSE
Credential:
Phone: 952-836-2234