Provider Demographics
NPI:1588006886
Name:PEOPLE UNITED OF LOUISIANA LLC
Entity Type:Organization
Organization Name:PEOPLE UNITED OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:225-756-4494
Mailing Address - Street 1:PO BOX 77053
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7053
Mailing Address - Country:US
Mailing Address - Phone:225-756-4494
Mailing Address - Fax:225-756-4495
Practice Address - Street 1:3600 JACKSON ST EXT STE 130
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3064
Practice Address - Country:US
Practice Address - Phone:225-756-4494
Practice Address - Fax:225-756-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 252Y00000X
LA2203781706302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency