Provider Demographics
NPI:1376719369
Name:GREATER NEW ORLEANS SUPPORTS AND SERVICES CENTER
Entity Type:Organization
Organization Name:GREATER NEW ORLEANS SUPPORTS AND SERVICES CENTER
Other - Org Name:HECTOR STREET COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MRDD REGIONAL ADMINISTRATOR 4
Authorized Official - Prefix:MR
Authorized Official - First Name:KIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-364-6600
Mailing Address - Street 1:4460 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3529
Mailing Address - Country:US
Mailing Address - Phone:504-364-6600
Mailing Address - Fax:503-364-6651
Practice Address - Street 1:4460 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3529
Practice Address - Country:US
Practice Address - Phone:504-364-6600
Practice Address - Fax:503-364-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1021320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities