Provider Demographics
NPI:1093168387
Name:EKHAYA YOUTH
Entity Type:Organization
Organization Name:EKHAYA YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-444-9379
Mailing Address - Street 1:1112 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6008
Mailing Address - Country:US
Mailing Address - Phone:504-373-6026
Mailing Address - Fax:
Practice Address - Street 1:2016 ROBERT ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5634
Practice Address - Country:US
Practice Address - Phone:504-444-9379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health