Healthcare Provider Details

I. General information

NPI: 1962763037
Provider Name (Legal Business Name): CHOICE FOUNDATION DBA MCDONOGH 42
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 N TONTI ST
NEW ORLEANS LA
70119-2540
US

IV. Provider business mailing address

2727 S CARROLLTON AVE
NEW ORLEANS LA
70118-4338
US

V. Phone/Fax

Practice location:
  • Phone: 504-942-3660
  • Fax:
Mailing address:
  • Phone: 504-861-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. JAMES FULTON
Title or Position: CFO
Credential: MBA
Phone: 504-861-0659