MEDICARE: ANNETTE

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	320800000X	Mental Illness Community Based Residential Treatment Facility		LA

General Provider Information

NPI Number	:	1265604672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNETTE

Provider Business Mailing Address
First Line	:	PO BOX 6041
Second Line	:	143CYPROVE GROVE
City	:	NEW ORLEANS
State	:	LA
Zip	:	70174-6041
Country	:	US
Telephone Number	:	504-274-6190
Fax Number	:	504-333-6179

Provider Business Practice Location Address
First Line	:	143 CYPRESS GROVE CT
Second Line	:	143CYPRESS GROVE
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-8562
Country	:	US
Telephone Number	:	504-274-6190
Fax Number	:	504-333-6179

Authorized Official
Title or Position	:	OWNER
Name	:	ANNETTE M WARREN
Credential	:
Telephone Number	:	504-274-6190

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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Directions to “ANNETTE ” Practice Location

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