Provider Demographics
NPI:1811225527
Name:ETERNAL CRISIS OUTREACH
Entity Type:Organization
Organization Name:ETERNAL CRISIS OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:225-326-9166
Mailing Address - Street 1:5759 WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70812-2355
Mailing Address - Country:US
Mailing Address - Phone:225-387-8240
Mailing Address - Fax:225-387-8241
Practice Address - Street 1:5759 WRIGHT DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-2355
Practice Address - Country:US
Practice Address - Phone:225-326-9166
Practice Address - Fax:225-354-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 27018251B00000X
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1889971Medicaid
LA1889962Medicaid
LA1889989Medicaid