Healthcare Provider Details

I. General information

NPI: 1750348462
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 GREENWOOD RD
SHREVEPORT LA
71119-8413
US

IV. Provider business mailing address

6240 GREENWOOD RD
SHREVEPORT LA
71119-8413
US

V. Phone/Fax

Practice location:
  • Phone: 318-632-2010
  • Fax: 318-632-2055
Mailing address:
  • Phone: 318-632-2010
  • Fax: 318-632-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number012
License Number StateLA

VIII. Authorized Official

Name: GEORGE SEWELL
Title or Position: FACILITY MANAGER
Credential:
Phone: 318-632-2010