Provider Demographics
NPI:1083795991
Name:SOUTHEAST LOUISIANA VETERANS HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:SOUTHEAST LOUISIANA VETERANS HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED RESPIRATORY THERAPY TECH
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-948-9809
Mailing Address - Street 1:3403 ALLEN ST.
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70111-2913
Mailing Address - Country:US
Mailing Address - Phone:504-948-9809
Mailing Address - Fax:
Practice Address - Street 1:1601 PERDIDO ST,
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-568-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALT1561261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center