Provider Demographics
NPI:1962641647
Name:SELF-ENHANCEMENT CENTER, INC.
Entity Type:Organization
Organization Name:SELF-ENHANCEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-289-6854
Mailing Address - Street 1:2825 A P TUREAUD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-1009
Mailing Address - Country:US
Mailing Address - Phone:504-289-6854
Mailing Address - Fax:504-304-6673
Practice Address - Street 1:2825 A P TUREAUD AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-1009
Practice Address - Country:US
Practice Address - Phone:504-289-6854
Practice Address - Fax:504-304-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACHILDREN'S CHOICEMedicaid