Provider Demographics
NPI:1124376165
Name:LOUIS INFANT CRISIS CENTER
Entity Type:Organization
Organization Name:LOUIS INFANT CRISIS CENTER
Other - Org Name:EL PASO HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-872-4984
Mailing Address - Street 1:PO BOX 2866
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-2866
Mailing Address - Country:US
Mailing Address - Phone:985-872-4984
Mailing Address - Fax:985-872-0017
Practice Address - Street 1:221 EL PASO DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-7309
Practice Address - Country:US
Practice Address - Phone:985-872-4984
Practice Address - Fax:985-872-0017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYOU AREA CHILDREN'S FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11609322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000000OtherNON-MEDICAL GROUP HOME CONTRACTING WITH MAGELLAN FOR MEDICAID REIMBURSEMENT