Provider Demographics
NPI:1336456029
Name:COUSHATTA TRIBE OF LOUISIANA
Entity Type:Organization
Organization Name:COUSHATTA TRIBE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-584-1439
Mailing Address - Street 1:2003 C C BEL RD
Mailing Address - Street 2:
Mailing Address - City:ELTON
Mailing Address - State:LA
Mailing Address - Zip Code:70532-5318
Mailing Address - Country:US
Mailing Address - Phone:337-584-1439
Mailing Address - Fax:337-584-1473
Practice Address - Street 1:2003 C C BEL RD
Practice Address - Street 2:
Practice Address - City:ELTON
Practice Address - State:LA
Practice Address - Zip Code:70532-5318
Practice Address - Country:US
Practice Address - Phone:337-584-1439
Practice Address - Fax:337-584-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center