Provider Demographics
NPI:1043513385
Name:PROGRESSIVE ACUTE CARE OAKDALE, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE ACUTE CARE OAKDALE, LLC
Other - Org Name:FOREST HILL FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-626-6134
Mailing Address - Street 1:11424 HWY 165 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:LA
Mailing Address - Zip Code:71430
Mailing Address - Country:US
Mailing Address - Phone:318-748-4645
Mailing Address - Fax:318-748-4689
Practice Address - Street 1:11424 HWY 165 SOUTH
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:LA
Practice Address - Zip Code:71430
Practice Address - Country:US
Practice Address - Phone:318-748-4645
Practice Address - Fax:318-748-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2155351Medicaid