Provider Demographics
NPI:1558594457
Name:A-1 CUSTOMIZED COMPANION SERVICES
Entity Type:Organization
Organization Name:A-1 CUSTOMIZED COMPANION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHUN
Authorized Official - Middle Name:SENELL
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:504-368-5545
Mailing Address - Street 1:2100 BELLE CHASSE HWY # B
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6651
Mailing Address - Country:US
Mailing Address - Phone:504-368-5545
Mailing Address - Fax:504-368-5509
Practice Address - Street 1:2100 BELLE CHASSE HWY # B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6651
Practice Address - Country:US
Practice Address - Phone:504-368-5545
Practice Address - Fax:504-368-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00014Medicaid