Provider Demographics
NPI:1346453669
Name:INTERLINK HEALTH CARE HOME AND COMMUNITY BASED WAIVER
Entity Type:Organization
Organization Name:INTERLINK HEALTH CARE HOME AND COMMUNITY BASED WAIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGEDENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EAGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-342-0138
Mailing Address - Street 1:3525 PRYTANIA ST STE 608
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-8106
Mailing Address - Country:US
Mailing Address - Phone:504-891-8100
Mailing Address - Fax:504-891-8156
Practice Address - Street 1:75 DOMINICAN DRIVE, STE. 201
Practice Address - Street 2:
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-652-1847
Practice Address - Fax:985-652-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 7065302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPCA 7065Medicaid