Healthcare Provider Details

I. General information

NPI: 1942205794
Provider Name (Legal Business Name): MARY JOSEPH RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 WOODLAND DR
NEW ORLEANS LA
70131-7339
US

IV. Provider business mailing address

4201 WOODLAND DR
NEW ORLEANS LA
70131-7339
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-2200
  • Fax:
Mailing address:
  • Phone: 504-391-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number19E123
License Number StateLA

VIII. Authorized Official

Name: SISTER PAUL
Title or Position: MOTHER
Credential:
Phone: 504-394-2200