Healthcare Provider Details

I. General information

NPI: 1104044882
Provider Name (Legal Business Name): LIBERATION OF THE AMERICAN FAMILY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AURORA DR
NEW ORLEANS LA
70131-2001
US

IV. Provider business mailing address

PO BOX 740594
NEW ORLEANS LA
70174-0594
US

V. Phone/Fax

Practice location:
  • Phone: 504-433-2722
  • Fax: 504-433-2138
Mailing address:
  • Phone: 504-433-2722
  • Fax: 504-433-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number9444
License Number StateLA

VIII. Authorized Official

Name: LINDA JONES
Title or Position: EXECUTIVE
Credential: GSW
Phone: 504-433-2722