Provider Demographics
NPI:1093222747
Name:THE GUILD AT RAPHAEL VILLAGE LLC
Entity Type:Organization
Organization Name:THE GUILD AT RAPHAEL VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-482-0058
Mailing Address - Street 1:517 SORAPARU ST APT 104
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-2001
Mailing Address - Country:US
Mailing Address - Phone:504-628-6876
Mailing Address - Fax:504-482-0059
Practice Address - Street 1:3401 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6207
Practice Address - Country:US
Practice Address - Phone:504-482-0058
Practice Address - Fax:504-482-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783583251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1184154858Medicaid