Provider Demographics
NPI:1346626801
Name:SOUTHEAST LOUISIANA WAR VETERANS HOME
Entity Type:Organization
Organization Name:SOUTHEAST LOUISIANA WAR VETERANS HOME
Other - Org Name:SOUTHEAST LOUISIANA WAR VETERANS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACISTS-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-479-4080
Mailing Address - Street 1:4080 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5712
Mailing Address - Country:US
Mailing Address - Phone:985-479-4080
Mailing Address - Fax:985-479-4091
Practice Address - Street 1:4080 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5712
Practice Address - Country:US
Practice Address - Phone:985-479-4080
Practice Address - Fax:985-479-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY0058213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153438OtherPK