Provider Demographics
NPI:1376909036
Name:ONE DIRECTION HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ONE DIRECTION HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:985-214-9079
Mailing Address - Street 1:103 GALERIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1246
Mailing Address - Country:US
Mailing Address - Phone:985-214-9079
Mailing Address - Fax:985-214-7178
Practice Address - Street 1:103 GALERIA BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1246
Practice Address - Country:US
Practice Address - Phone:985-214-9079
Practice Address - Fax:985-214-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2023-01-11
Deactivation Date:2018-08-28
Deactivation Code:
Reactivation Date:2018-09-06
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QM0855X
LAAP08166261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2411241Medicaid