Provider Demographics
NPI:1508335910
Name:OH PROJECT- SOUTHSHORE
Entity Type:Organization
Organization Name:OH PROJECT- SOUTHSHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEQUILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-450-6769
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-0957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23515 U.S. 190
Practice Address - Street 2:NORTHLAKE ACADEMY BUILDING
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447
Practice Address - Country:US
Practice Address - Phone:985-276-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty