Provider Demographics
NPI:1326002155
Name:DEPART. HEALTH AND HOSPITALS
Entity Type:Organization
Organization Name:DEPART. HEALTH AND HOSPITALS
Other - Org Name:RED RIVER MEDICALLY SUPPORTED DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INPATIENT FACILITY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:G
Authorized Official - Last Name:CANNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:318-484-6661
Mailing Address - Street 1:PO BOX 7118
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0118
Mailing Address - Country:US
Mailing Address - Phone:318-484-6400
Mailing Address - Fax:318-487-5703
Practice Address - Street 1:C/O CENTRAL STATE HOSPITAL, UNIT 6, MEADOW LANE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6400
Practice Address - Fax:318-487-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA162276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit