Provider Demographics
NPI:1215199112
Name:CENTER FOR RELIEF OF SUFFERING
Entity Type:Organization
Organization Name:CENTER FOR RELIEF OF SUFFERING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-264-5413
Mailing Address - Street 1:101 E FAIRWAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7503
Mailing Address - Country:US
Mailing Address - Phone:985-871-1181
Mailing Address - Fax:985-871-1189
Practice Address - Street 1:101 E FAIRWAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7503
Practice Address - Country:US
Practice Address - Phone:985-871-1181
Practice Address - Fax:985-871-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308951Medicaid
LA1308951Medicaid