=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528335627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGNMENT HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 11/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5334 HIGHWAY 311
-----------------------------------------------------
City | HOUMA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70360-2880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-432-7093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 S DIAMOND ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70130-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-858-2992
-----------------------------------------------------
Fax | 985-858-2990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEORGE D GROVE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 504-432-7093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD201344
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------