Provider Demographics
NPI:1942419148
Name:METROPOLITAN DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:METROPOLITAN DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-394-1200
Mailing Address - Street 1:251 F EDWARD HEBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-3003
Mailing Address - Country:US
Mailing Address - Phone:504-394-1200
Mailing Address - Fax:505-398-9200
Practice Address - Street 1:251 F EDWARD HEBERT BLVD
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-3003
Practice Address - Country:US
Practice Address - Phone:504-394-1200
Practice Address - Fax:505-398-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA99100054315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1712027Medicaid