Provider Demographics
NPI:1265676860
Name:DEPARTMENT OF HEALTH & HOSPITAL
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH & HOSPITAL
Other - Org Name:FPHSA/HAMMOND A D C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:JR
Authorized Official - Credentials:GSW
Authorized Official - Phone:985-543-4070
Mailing Address - Street 1:1920 FLORIDA AVE SW
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4970
Mailing Address - Country:US
Mailing Address - Phone:225-665-0473
Mailing Address - Fax:225-665-0283
Practice Address - Street 1:1920 FLORIDA AVE SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4970
Practice Address - Country:US
Practice Address - Phone:225-665-0473
Practice Address - Fax:225-665-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA395A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder