Provider Demographics
NPI:1225219298
Name:INTERLINK HOMEAND COMMUNITY BASED WAIVER
Entity Type:Organization
Organization Name:INTERLINK HOMEAND COMMUNITY BASED WAIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OKPALOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-652-1847
Mailing Address - Street 1:75 DOMINICAN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3400
Mailing Address - Country:US
Mailing Address - Phone:985-652-1847
Mailing Address - Fax:985-652-1897
Practice Address - Street 1:75 DOMINICAN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3400
Practice Address - Country:US
Practice Address - Phone:985-652-1847
Practice Address - Fax:985-652-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAPPLIED FORMedicaid