Provider Demographics
NPI:1083194393
Name:PLTC-LLC
Entity Type:Organization
Organization Name:PLTC-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:MOGILLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-827-2701
Mailing Address - Street 1:3330 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6206
Mailing Address - Country:US
Mailing Address - Phone:504-827-2701
Mailing Address - Fax:504-827-2715
Practice Address - Street 1:3330 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6206
Practice Address - Country:US
Practice Address - Phone:504-827-2701
Practice Address - Fax:504-827-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2136593Medicaid