Provider Demographics
NPI:1659621332
Name:ANIOMA INC.
Entity Type:Organization
Organization Name:ANIOMA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPALOBI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-240-3056
Mailing Address - Street 1:4030 PONCHATRAIN DR.
Mailing Address - Street 2:MAILBOX 305
Mailing Address - City:SLIDELL
Mailing Address - State:NEW ORLEANS
Mailing Address - Zip Code:70458
Mailing Address - Country:UM
Mailing Address - Phone:504-240-3056
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD
Practice Address - Street 2:SUITE 616
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6200
Practice Address - Country:US
Practice Address - Phone:504-240-3056
Practice Address - Fax:504-324-0409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANIOMA LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-11
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health