Healthcare Provider Details

I. General information

NPI: 1366814469
Provider Name (Legal Business Name): BAYOU HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 POYDRAS ST
NEW ORLEANS LA
70112-1254
US

IV. Provider business mailing address

1615 POYDRAS ST
NEW ORLEANS LA
70112-1254
US

V. Phone/Fax

Practice location:
  • Phone: 504-919-0039
  • Fax:
Mailing address:
  • Phone: 504-919-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID GAINES
Title or Position: OWNER/CEO
Credential:
Phone: 504-919-0039