Provider Demographics
NPI:1043999170
Name:AZALEA HEALTH SERVICES
Entity Type:Organization
Organization Name:AZALEA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-519-1834
Mailing Address - Street 1:725 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4405
Mailing Address - Country:US
Mailing Address - Phone:337-393-0678
Mailing Address - Fax:337-279-2705
Practice Address - Street 1:725 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4405
Practice Address - Country:US
Practice Address - Phone:337-393-0678
Practice Address - Fax:337-279-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty