Healthcare Provider Details

I. General information

NPI: 1790158681
Provider Name (Legal Business Name): NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 FERRAND ST
MONROE LA
71201-3210
US

IV. Provider business mailing address

2525 FERRAND ST
MONROE LA
71201-3210
US

V. Phone/Fax

Practice location:
  • Phone: 318-362-3270
  • Fax: 318-362-3268
Mailing address:
  • Phone: 318-362-3270
  • Fax: 318-362-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OCTAVIA GREEN
Title or Position: ADMINISTRATIVE PROGRAM SPECIALIST B
Credential:
Phone: 318-362-3270