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General NPI Number Information
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NPI Number | 1225782196
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Entity Type | Organization
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Legal Business Name | NORTHEAST DELTA HUMAN SERVICES AUTHORITY
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 451 E MADISON AVE
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City | BASTROP
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State | LA
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Zip | 71220-3829
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Country | US
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Telephone | 318-283-0868
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Fax | 318-556-7090
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Provider Business Mailing Address
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Address Line | 450 E PINE STREET
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City | BASTROP
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State | LA
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Zip | 71220-3840
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Country | US
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Telephone | 318-283-0868
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Fax | 318-283-0875
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Authorized Official
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Title or Position | ADMINISTRATIVE PROGRAM MANAGER
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Name | OCTAVIA GREEN
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Credential |
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Telephone | 318-362-3270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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