Provider Demographics
NPI:1245418284
Name:PARISHES SUPPORTIVE LIVING
Entity Type:Organization
Organization Name:PARISHES SUPPORTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:VINING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-386-0898
Mailing Address - Street 1:112 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-2602
Mailing Address - Country:US
Mailing Address - Phone:985-386-0898
Mailing Address - Fax:985-370-5788
Practice Address - Street 1:112 S 3RD ST
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-2602
Practice Address - Country:US
Practice Address - Phone:985-386-0898
Practice Address - Fax:985-370-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1743411Medicaid