Provider Demographics
NPI:1871241182
Name:COLLABORATIVE HEALTH NOLA, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE HEALTH NOLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NIKESHA
Authorized Official - Middle Name:GUICE
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-345-6217
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0295
Mailing Address - Country:US
Mailing Address - Phone:504-345-6217
Mailing Address - Fax:
Practice Address - Street 1:2401 IDAHO AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5715
Practice Address - Country:US
Practice Address - Phone:504-466-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility