Provider Demographics
NPI:1861512295
Name:ANIOMA LIVING, INC.
Entity Type:Organization
Organization Name:ANIOMA LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:DENE
Authorized Official - Last Name:OKPALOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-368-9191
Mailing Address - Street 1:1799 STUMPF BLVD
Mailing Address - Street 2:BUILDING 7 SUITE 5B
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3950
Mailing Address - Country:US
Mailing Address - Phone:504-368-9191
Mailing Address - Fax:504-368-9192
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BUILDING 7 SUITE 5B
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-368-9191
Practice Address - Fax:504-368-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 7077251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1009555Medicaid
LA1009555Medicaid