MEDICARE: MARY JOSEPH RESIDENCE

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	313M00000X	Nursing Facility/Intermediate Care Facility	19E123	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942205794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY JOSEPH RESIDENCE

Provider Business Mailing Address
First Line	:	4201 WOODLAND DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-7339
Country	:	US
Telephone Number	:	504-391-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 WOODLAND DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-7339
Country	:	US
Telephone Number	:	504-391-2200
Fax Number	:

Authorized Official
Title or Position	:	MOTHER
Name	:	SISTER PAUL
Credential	:
Telephone Number	:	504-394-2200

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/22/2020

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Directions to “MARY JOSEPH RESIDENCE ” Practice Location

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