Provider Demographics
NPI:1083886089
Name:VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.
Other - Org Name:VOLUNTEERS OF AMERICA GREATER NEW ORLEANS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE & ADMINIS
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-482-2130
Mailing Address - Street 1:4152 CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5941
Mailing Address - Country:US
Mailing Address - Phone:504-482-2130
Mailing Address - Fax:504-482-1922
Practice Address - Street 1:118 SOUTH OLYMPIA STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5818
Practice Address - Country:US
Practice Address - Phone:504-313-1039
Practice Address - Fax:985-259-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203780145320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1716774Medicaid