Provider Demographics
NPI:1386016848
Name:999999
Entity Type:Organization
Organization Name:999999
Other - Org Name:999999
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-841-2209
Mailing Address - Street 1:1013 N CAUSEWAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4100
Mailing Address - Country:US
Mailing Address - Phone:504-841-2209
Mailing Address - Fax:504-828-8025
Practice Address - Street 1:1013 N CAUSEWAY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-4100
Practice Address - Country:US
Practice Address - Phone:504-841-2209
Practice Address - Fax:504-828-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital