Provider Demographics
NPI: | 1801031133 |
---|---|
Name: | ST. MARY PARISH GOVERNMENT/FAIRVIEW TREATMENT CENTE |
Entity Type: | Organization |
Organization Name: | ST. MARY PARISH GOVERNMENT/FAIRVIEW TREATMENT CENTE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | LEESE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LAC/CCS |
Authorized Official - Phone: | 985-395-6750 |
Mailing Address - Street 1: | 1101 SOUTHEAST BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | MORGAN CITY |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70380-5933 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 985-395-6750 |
Mailing Address - Fax: | 985-395-6794 |
Practice Address - Street 1: | 1101 SOUTHEAST BLVD |
Practice Address - Street 2: | |
Practice Address - City: | MORGAN CITY |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70380-5933 |
Practice Address - Country: | US |
Practice Address - Phone: | 985-395-6750 |
Practice Address - Fax: | 985-395-6794 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-12-16 |
Last Update Date: | 2008-12-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |