Provider Demographics
NPI:1912386640
Name:NOLA, PRIDE-WFH LLC
Entity Type:Organization
Organization Name:NOLA, PRIDE-WFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-458-0370
Mailing Address - Street 1:700 PHOSPHOR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005
Mailing Address - Country:US
Mailing Address - Phone:504-287-4160
Mailing Address - Fax:504-305-0454
Practice Address - Street 1:700 PHOSPHOR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:504-287-4160
Practice Address - Fax:504-305-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health