Provider Demographics
NPI:1548384910
Name:DIRECTIONS OF LOUISIANA, INC
Entity Type:Organization
Organization Name:DIRECTIONS OF LOUISIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-640-4340
Mailing Address - Street 1:5427 SHREVEPORT HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-3531
Mailing Address - Country:US
Mailing Address - Phone:318-640-4340
Mailing Address - Fax:318-640-4160
Practice Address - Street 1:5427 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-3531
Practice Address - Country:US
Practice Address - Phone:318-640-4340
Practice Address - Fax:318-640-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM2052171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1547034Medicaid
LA1698253Medicaid