Provider Demographics
NPI:1073850277
Name:THE BETTY AND LEONARD PHILLIPS DEAF ACTION CENTER
Entity Type:Organization
Organization Name:THE BETTY AND LEONARD PHILLIPS DEAF ACTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HYLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-425-7781
Mailing Address - Street 1:601 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4748
Mailing Address - Country:US
Mailing Address - Phone:318-425-7781
Mailing Address - Fax:318-226-1299
Practice Address - Street 1:601 JORDAN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4748
Practice Address - Country:US
Practice Address - Phone:318-425-7781
Practice Address - Fax:318-226-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0011028251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0011028Medicaid