Healthcare Provider Details

I. General information

NPI: 1356095236
Provider Name (Legal Business Name): NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WHITE ST
RUSTON LA
71270-5960
US

IV. Provider business mailing address

901 WHITE ST
RUSTON LA
71270-5960
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-4125
  • Fax: 318-251-5000
Mailing address:
  • Phone: 318-251-4125
  • Fax: 318-251-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OCTAVIA GREEN
Title or Position: ADMINISTRATIVE PROGRAM SPECIALIST B
Credential:
Phone: 318-362-3270