Provider Demographics
NPI:1467683458
Name:UNITED CEREBRAL PALSY OF G.N.O., INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF G.N.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-461-4266
Mailing Address - Street 1:2200 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-4001
Mailing Address - Country:US
Mailing Address - Phone:504-461-4266
Mailing Address - Fax:504-461-9976
Practice Address - Street 1:2200 VETERANS MEMORIAL BLVD
Practice Address - Street 2:STE 103
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4001
Practice Address - Country:US
Practice Address - Phone:504-461-4266
Practice Address - Fax:504-461-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4502096252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4502096Medicaid