Provider Demographics
NPI:1437522034
Name:IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Entity Type:Organization
Organization Name:IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Other - Org Name:IMCAL BH JEFFERSON DAVIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NRHCMC
Authorized Official - Phone:337-475-8701
Mailing Address - Street 1:437 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5857
Mailing Address - Country:US
Mailing Address - Phone:337-246-7325
Mailing Address - Fax:337-246-7328
Practice Address - Street 1:437 N MARKET ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5857
Practice Address - Country:US
Practice Address - Phone:337-246-7325
Practice Address - Fax:337-246-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA95-C261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)