Provider Demographics
NPI:1851691067
Name:ST ANTHONY OUTREACH INC
Entity Type:Organization
Organization Name:ST ANTHONY OUTREACH INC
Other - Org Name:ST ANTHONY OUTREACH INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-301-7038
Mailing Address - Street 1:737 PAUL MAILLARD RD
Mailing Address - Street 2:P O BOX 1213
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4343
Mailing Address - Country:US
Mailing Address - Phone:504-301-7038
Mailing Address - Fax:
Practice Address - Street 1:737 PAUL MAILLARD RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4343
Practice Address - Country:US
Practice Address - Phone:504-301-7038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA03-05-1506Medicaid