Provider Demographics
NPI:1497815815
Name:OPH-REGION 4-NURSE-FAMILY PARTNERSHIP PROGRAM
Entity Type:Organization
Organization Name:OPH-REGION 4-NURSE-FAMILY PARTNERSHIP PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGION 4-NFP SUPERVISOR-PHN-5
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:337-262-5319
Mailing Address - Street 1:825 KALISTE SALOOM RD
Mailing Address - Street 2:BRANDYWINE III, SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4284
Mailing Address - Country:US
Mailing Address - Phone:337-262-5319
Mailing Address - Fax:337-262-5237
Practice Address - Street 1:825 KALISTE SALOOM RD
Practice Address - Street 2:BRANDYWINE III, SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4284
Practice Address - Country:US
Practice Address - Phone:337-262-5319
Practice Address - Fax:337-262-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 9912251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1567124Medicaid