Provider Demographics
NPI:1578681359
Name:EASTER SEALS LOUISIANA INC.
Entity Type:Organization
Organization Name:EASTER SEALS LOUISIANA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-523-7325
Mailing Address - Street 1:1010 COMMON STREET
Mailing Address - Street 2:SUITE 2440
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2449
Mailing Address - Country:US
Mailing Address - Phone:504-523-7325
Mailing Address - Fax:504-523-3465
Practice Address - Street 1:1513 LINE AVENUE
Practice Address - Street 2:SUITE 355
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-221-8244
Practice Address - Fax:318-221-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACM0006484Medicaid