Provider Demographics
NPI:1962468819
Name:DEPARTMENT OF HEALTH AND HOSPITALS
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND HOSPITALS
Other - Org Name:OBH-RUSTON ADDICTIVE DISORDERS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OAD/REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:JERRI
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:318-362-3270
Mailing Address - Street 1:602 E GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3931
Mailing Address - Country:US
Mailing Address - Phone:318-251-4125
Mailing Address - Fax:318-251-5000
Practice Address - Street 1:602 E GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3931
Practice Address - Country:US
Practice Address - Phone:318-251-4125
Practice Address - Fax:318-251-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA880101YA0400X
LACAC1223101YA0400X
LARAC1224101YA0400X
LALCSW 45181041C0700X
LAMD010285261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH2376OtherBCBSLA
LAH2376OtherBCBSLA