MEDICARE: LEVELS OF INTENSIVE FAMILY TREATMENT, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1669907564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVELS OF INTENSIVE FAMILY TREATMENT, LLC

Provider Business Mailing Address
First Line	:	4422 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-4830
Country	:	US
Telephone Number	:	504-891-3264
Fax Number	:	504-891-1172

Provider Business Practice Location Address
First Line	:	4422 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-4830
Country	:	US
Telephone Number	:	504-891-3264
Fax Number	:	504-891-1172

Authorized Official
Title or Position	:	CEO
Name	:	PAT WATSON
Credential	:
Telephone Number	:	504-259-7642

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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