Provider Demographics
NPI:1699806398
Name:A&E ADVANTAGE
Entity Type:Organization
Organization Name:A&E ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALVINA
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:MATHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MADS
Authorized Official - Phone:985-758-2394
Mailing Address - Street 1:107 WARREN DR
Mailing Address - Street 2:
Mailing Address - City:DES ALLEMANDS
Mailing Address - State:LA
Mailing Address - Zip Code:70030-3338
Mailing Address - Country:US
Mailing Address - Phone:985-758-2394
Mailing Address - Fax:985-758-3742
Practice Address - Street 1:107 WARREN DR
Practice Address - Street 2:
Practice Address - City:DES ALLEMANDS
Practice Address - State:LA
Practice Address - Zip Code:70030-3338
Practice Address - Country:US
Practice Address - Phone:985-758-2394
Practice Address - Fax:985-758-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM4890251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621366Medicaid