Provider Demographics
NPI:1275745713
Name:NEW WAY OF SOUTHWEST LA
Entity Type:Organization
Organization Name:NEW WAY OF SOUTHWEST LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-3703
Mailing Address - Street 1:2683 VIDRINE ROAD
Mailing Address - Street 2:P.O. BOX 363
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586
Mailing Address - Country:US
Mailing Address - Phone:337-363-3703
Mailing Address - Fax:337-363-4008
Practice Address - Street 1:2683 VIDRINE ROAD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-363-3703
Practice Address - Fax:337-363-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1142590Medicaid