Provider Demographics
NPI:1164652301
Name:THE FOODBANK OF COVINGTON, LOUISIANA, INC.
Entity Type:Organization
Organization Name:THE FOODBANK OF COVINGTON, LOUISIANA, INC.
Other - Org Name:ALL SAINTS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-871-3939
Mailing Address - Street 1:840 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2108
Mailing Address - Country:US
Mailing Address - Phone:985-871-3939
Mailing Address - Fax:
Practice Address - Street 1:840 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2108
Practice Address - Country:US
Practice Address - Phone:985-871-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental