Provider Demographics
NPI:1215033535
Name:CENTRAL LA STATE HOSPITAL
Entity Type:Organization
Organization Name:CENTRAL LA STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT SUPERVISOR 2
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-484-6935
Mailing Address - Street 1:PO BOX 5031
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361-5031
Mailing Address - Country:US
Mailing Address - Phone:318-484-6308
Mailing Address - Fax:318-484-6879
Practice Address - Street 1:242 W SHAMROCK AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6200
Practice Address - Fax:318-484-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA217283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710555Medicaid
LA1710555Medicaid
LA194025Medicare PIN