MEDICARE: EASTER SEALS LOUISIANA

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	251B00000X	Case Management Agency		LA

General Provider Information

NPI Number	:	1972728368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEALS LOUISIANA

Provider Business Mailing Address
First Line	:	1010 COMMON ST
Second Line	:	SUITE 2000
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 CENTENARY BLVD
Second Line	:	BLDG 3 SUITE 180
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3356
Country	:	US
Telephone Number	:	318-221-8244
Fax Number	:	318-221-8726

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DANIEL UNDERWOOD
Credential	:
Telephone Number	:	504-523-7325

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/22/2020

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Directions to “EASTER SEALS LOUISIANA ” Practice Location

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