Healthcare Provider Details

I. General information

NPI: 1023075017
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH & HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 NORTH HEARNE AVENUE
SHREVEPORT LA
71107
US

IV. Provider business mailing address

P.O. BOX 7904
SHREVEPORT LA
71107
US

V. Phone/Fax

Practice location:
  • Phone: 318-632-2040
  • Fax: 318-632-2073
Mailing address:
  • Phone: 318-676-5111
  • Fax: 318-676-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number115
License Number StateLA

VIII. Authorized Official

Name: MS. ALLIE D. ALLEN
Title or Position: ADMINISTRATIVE PROGRAM MANAGER
Credential:
Phone: 318-676-5111