Provider Demographics
NPI:1679672075
Name:A AND L OF NORTHEAST INC
Entity Type:Organization
Organization Name:A AND L OF NORTHEAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-8488
Mailing Address - Street 1:700 N 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4212
Mailing Address - Country:US
Mailing Address - Phone:318-325-5221
Mailing Address - Fax:
Practice Address - Street 1:700 N 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4212
Practice Address - Country:US
Practice Address - Phone:318-325-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1567370251B00000X
LA4629040001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1567361Medicaid
LA1171247Medicaid
LA1143944Medicaid
LA1567370Medicaid
LA1190357Medicaid
LA1436011Medicaid
LA1567353Medicaid
LA1143944Medicaid