MEDICARE: DEPARTMENT OF HEALTH AND HOSPITALS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	263	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60124	OTHER	LA	INSURANCE

General Provider Information

NPI Number	:	1215988241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF HEALTH AND HOSPITALS

Provider Business Mailing Address
First Line	:	PO BOX 244
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-0244
Country	:	US
Telephone Number	:	225-262-2474
Fax Number	:	225-262-3551

Provider Business Practice Location Address
First Line	:	23260 GREENWELL SPRINGS RD
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-6031
Country	:	US
Telephone Number	:	225-262-2474
Fax Number	:	225-262-3551

Authorized Official
Title or Position	:	OAD INPATIENT FACILITY MANAGER
Name	:	MRS. ALICE ROELING
Credential	:	LAC
Telephone Number	:	225-262-3559

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/21/2022

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Directions to “DEPARTMENT OF HEALTH AND HOSPITALS ” Practice Location

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