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General NPI Number Information
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NPI Number | 1104244078
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Entity Type | Organization
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Legal Business Name | OUR LADY OF THE LAKE RMC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 1145 BEECHWOOD DR
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City | HARVEY
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State | LA
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Zip | 70058-4332
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Country | US
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Telephone | 504-621-5247
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 BEECHWOOD DR
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City | HARVEY
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State | LA
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Zip | 70058-4332
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Country | US
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Telephone | 504-621-5247
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL EDUCATION
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Name | SHANTELLE GRAVES
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Credential | B.S.R.R.T
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Telephone | 225-202-4578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | LRT.000756
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License Number State | LA
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