Provider Demographics
NPI:1659636561
Name:EKHAYA YOUTH PROJECT, INC.
Entity Type:Organization
Organization Name:EKHAYA YOUTH PROJECT, INC.
Other - Org Name:LOUISIANA STATEWIDE FAMILY SUPPORT ORGANIZATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-858-4673
Mailing Address - Street 1:1112 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6008
Mailing Address - Country:US
Mailing Address - Phone:504-267-0470
Mailing Address - Fax:855-662-4366
Practice Address - Street 1:1112 5TH ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6008
Practice Address - Country:US
Practice Address - Phone:504-858-4673
Practice Address - Fax:855-662-4366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EKHAYA YOUTH PROJECT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-06
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
LA385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child