Provider Demographics
NPI:1922212695
Name:ANIOMA LIVING, INC.
Entity Type:Organization
Organization Name:ANIOMA LIVING, INC.
Other - Org Name:IBERVILLE COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:Q
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKPALOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-368-9191
Mailing Address - Street 1:PO BOX 8130
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70182-8130
Mailing Address - Country:US
Mailing Address - Phone:504-821-1140
Mailing Address - Fax:504-368-9192
Practice Address - Street 1:3228 IBERVILLE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5424
Practice Address - Country:US
Practice Address - Phone:504-821-1140
Practice Address - Fax:504-368-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1717932Medicaid