Provider Demographics
NPI:1588846661
Name:A SMALL WORLD IN THE RIVER REGION, INC.
Entity Type:Organization
Organization Name:A SMALL WORLD IN THE RIVER REGION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-328-1627
Mailing Address - Street 1:732 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5623
Mailing Address - Country:US
Mailing Address - Phone:504-328-1627
Mailing Address - Fax:504-328-1467
Practice Address - Street 1:732 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5623
Practice Address - Country:US
Practice Address - Phone:504-328-1627
Practice Address - Fax:504-328-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA97923747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1105228Medicaid