Provider Demographics
NPI:1891989679
Name:GREATER NEW ORLEANS SUPPORTS & SERVICES CENTER
Entity Type:Organization
Organization Name:GREATER NEW ORLEANS SUPPORTS & SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTIVE TREATMENT SPECIALIST 4
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-393-4006
Mailing Address - Street 1:234 F EDWARD HEBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:BELL CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037
Mailing Address - Country:US
Mailing Address - Phone:504-393-4006
Mailing Address - Fax:
Practice Address - Street 1:234 F EDWARD HEBERT BLVD
Practice Address - Street 2:
Practice Address - City:BELL CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037
Practice Address - Country:US
Practice Address - Phone:504-393-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561860Medicaid