Provider Demographics
NPI:1891030938
Name:DEPAETMENT OF HEALTH AND HOSPITALS
Entity Type:Organization
Organization Name:DEPAETMENT OF HEALTH AND HOSPITALS
Other - Org Name:MINDEN BEHAVIORAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYNE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-371-3348
Mailing Address - Street 1:435 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2933
Mailing Address - Country:US
Mailing Address - Phone:318-371-3348
Mailing Address - Fax:318-371-3300
Practice Address - Street 1:435 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2933
Practice Address - Country:US
Practice Address - Phone:318-371-3348
Practice Address - Fax:318-371-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN72650OtherSTATE BOARD OF LOUISIANA