Healthcare Provider Details

I. General information

NPI: 1265604672
Provider Name (Legal Business Name): ANNETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 CYPRESS GROVE CT 143CYPRESS GROVE
NEW ORLEANS LA
70131-8562
US

IV. Provider business mailing address

PO BOX 6041 143CYPROVE GROVE
NEW ORLEANS LA
70174-6041
US

V. Phone/Fax

Practice location:
  • Phone: 504-274-6190
  • Fax: 504-333-6179
Mailing address:
  • Phone: 504-274-6190
  • Fax: 504-333-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateLA

VIII. Authorized Official

Name: ANNETTE M WARREN
Title or Position: OWNER
Credential:
Phone: 504-274-6190