Provider Demographics
NPI:1205029535
Name:HAMMOND TANGIPAHOA JUNETEENTH
Entity Type:Organization
Organization Name:HAMMOND TANGIPAHOA JUNETEENTH
Other - Org Name:IRASH ADHC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-510-0129
Mailing Address - Street 1:115 W ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-3913
Mailing Address - Country:US
Mailing Address - Phone:985-510-0129
Mailing Address - Fax:985-345-2844
Practice Address - Street 1:311 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2650
Practice Address - Country:US
Practice Address - Phone:985-510-0129
Practice Address - Fax:985-345-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4127311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1119776Medicaid