Provider Demographics
NPI:1235340761
Name:HEALTH PARADIGM, LLC
Entity Type:Organization
Organization Name:HEALTH PARADIGM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-251-2322
Mailing Address - Street 1:615 S TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5040
Mailing Address - Country:US
Mailing Address - Phone:318-251-2322
Mailing Address - Fax:318-251-0710
Practice Address - Street 1:615 S TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5040
Practice Address - Country:US
Practice Address - Phone:318-251-2322
Practice Address - Fax:318-251-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACI 3505 LA101Y00000X
LA1164R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1681032Medicaid
LAF85704Medicare UPIN
LA5CC60Medicare PIN