Provider Demographics
NPI:1366687527
Name:NORTHWEST CMHC, L.L.C.
Entity Type:Organization
Organization Name:NORTHWEST CMHC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-892-6119
Mailing Address - Street 1:1813 ROSALE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8566
Mailing Address - Country:US
Mailing Address - Phone:225-892-6119
Mailing Address - Fax:
Practice Address - Street 1:2121 FAIRFIELD AVE
Practice Address - Street 2:SUITE 210/220
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2057
Practice Address - Country:US
Practice Address - Phone:225-892-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)