Provider Demographics
NPI:1730674557
Name:LOUISIANA DEPARTMENT OF HEALTH, DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type:Organization
Organization Name:LOUISIANA DEPARTMENT OF HEALTH, DEPARTMENT OF HEALTH AND HOSPITALS
Other - Org Name:STATE OF LOUISIANA, DEPARTMENT OF HEALTH, OFFICE OF AGING AND ADULT SE
Other - Org Type:Other Name
Authorized Official - Title/Position:OAAS ASSISTANT SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-219-0223
Mailing Address - Street 1:P.O. BOX 2031 , BIN #14
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70821
Mailing Address - Country:US
Mailing Address - Phone:225-219-0223
Mailing Address - Fax:225-219-0202
Practice Address - Street 1:612 HENRY CLAY AVE.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility