Provider Demographics
NPI:1154330652
Name:ST. LANDRY PARISH RURAL HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:ST. LANDRY PARISH RURAL HEALTH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MRS
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-2005
Mailing Address - Street 1:PO BOX 2234
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2234
Mailing Address - Country:US
Mailing Address - Phone:337-942-2880
Mailing Address - Fax:337-942-6367
Practice Address - Street 1:116 E VINE ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5152
Practice Address - Country:US
Practice Address - Phone:337-942-2880
Practice Address - Fax:337-942-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 6651251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACM6651OtherCASE MGMT LICENSE
LA1328774Medicaid
LA1528587Medicaid