Healthcare Provider Details

I. General information

NPI: 1326002155
Provider Name (Legal Business Name): DEPART. HEALTH AND HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O CENTRAL STATE HOSPITAL, UNIT 6, MEADOW LANE
PINEVILLE LA
71360
US

IV. Provider business mailing address

PO BOX 7118
ALEXANDRIA LA
71306-0118
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-6400
  • Fax: 318-487-5703
Mailing address:
  • Phone: 318-484-6400
  • Fax: 318-487-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number162
License Number StateLA

VIII. Authorized Official

Name: MRS. VICKI G CANNELLA
Title or Position: INPATIENT FACILITY MANAGER
Credential: LCSW-BACS
Phone: 318-484-6661