Provider Demographics
NPI:1154507234
Name:WESTERN OAKS LTD
Entity Type:Organization
Organization Name:WESTERN OAKS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-239-7461
Mailing Address - Street 1:7809 AIRLINE DR
Mailing Address - Street 2:SUITE 306-B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6439
Mailing Address - Country:US
Mailing Address - Phone:504-739-7928
Mailing Address - Fax:504-739-7930
Practice Address - Street 1:7809 AIRLINE DR
Practice Address - Street 2:SUITE 306-B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6439
Practice Address - Country:US
Practice Address - Phone:504-739-7928
Practice Address - Fax:504-739-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14067251E00000X, 261QM0855X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1014672Medicaid