Provider Demographics
NPI:1720213929
Name:NORTH LAKE SUPPORTS AND SERVICES CENTER
Entity Type:Organization
Organization Name:NORTH LAKE SUPPORTS AND SERVICES CENTER
Other - Org Name:NORTH LAKE SUPPORTS AND SERVICES CENTER EARLY STEPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-567-3111
Mailing Address - Street 1:45439 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401
Mailing Address - Country:US
Mailing Address - Phone:225-567-3111
Mailing Address - Fax:
Practice Address - Street 1:45439 LIVE OAK DR.
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401
Practice Address - Country:US
Practice Address - Phone:225-567-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency