Provider Demographics
NPI:1174820997
Name:PEOPLE UNITED OF LOUISIANA LLC
Entity Type:Organization
Organization Name:PEOPLE UNITED OF LOUISIANA LLC
Other - Org Name:PEOPLE UNITED OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-323-1300
Mailing Address - Street 1:PO BOX 77053
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7053
Mailing Address - Country:US
Mailing Address - Phone:318-323-1300
Mailing Address - Fax:318-323-1400
Practice Address - Street 1:1401 HUDSON LN
Practice Address - Street 2:STE 202
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6068
Practice Address - Country:US
Practice Address - Phone:318-323-1300
Practice Address - Fax:318-323-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 27048251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACM 27048Medicaid