Provider Demographics
NPI:1659551786
Name:AN ANGEL'S TOUCH OF THE RIVER REGION INC
Entity Type:Organization
Organization Name:AN ANGEL'S TOUCH OF THE RIVER REGION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-651-7887
Mailing Address - Street 1:121 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-4175
Mailing Address - Country:US
Mailing Address - Phone:985-651-7887
Mailing Address - Fax:
Practice Address - Street 1:121 MARIE ST
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-4175
Practice Address - Country:US
Practice Address - Phone:985-651-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AN ANGEL'S TOUCH OF THE RIVER REGION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9580302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1179752Medicaid