Provider Demographics
NPI:1235320797
Name:ABILICARE
Entity Type:Organization
Organization Name:ABILICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MSN, HCSM
Authorized Official - Phone:504-739-1001
Mailing Address - Street 1:7809 AIRLINE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6439
Mailing Address - Country:US
Mailing Address - Phone:504-739-1001
Mailing Address - Fax:504-739-1002
Practice Address - Street 1:7809 AIRLINE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6439
Practice Address - Country:US
Practice Address - Phone:504-739-1001
Practice Address - Fax:504-739-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1108243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1108103Medicaid