Provider Demographics
NPI:1891749834
Name:PREEMINENT HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:PREEMINENT HEALTHCARE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-5262
Mailing Address - Street 1:325 N AVENUE F
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5042
Mailing Address - Country:US
Mailing Address - Phone:337-783-5262
Mailing Address - Fax:337-783-5264
Practice Address - Street 1:7515 CAMERON ST
Practice Address - Street 2:
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529-3312
Practice Address - Country:US
Practice Address - Phone:337-456-3392
Practice Address - Fax:337-456-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9562251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1120022Medicaid