Provider Demographics
NPI:1962627364
Name:EASTERN LA. MENTAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:EASTERN LA. MENTAL HEALTH SYSTEM
Other - Org Name:T. N. ARMISTEAD, RESIDENCE #165
Other - Org Type:Other Name
Authorized Official - Title/Position:ADM. CO. 4
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-634-0661
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:LA
Mailing Address - Zip Code:70748-0498
Mailing Address - Country:US
Mailing Address - Phone:225-634-0661
Mailing Address - Fax:225-634-0361
Practice Address - Street 1:4502 HWY 951
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:LA
Practice Address - Zip Code:70748
Practice Address - Country:US
Practice Address - Phone:225-634-0661
Practice Address - Fax:225-634-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA711283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1712302Medicaid