Provider Demographics
NPI:1962681544
Name:JANE LOCKETT HARTMAN OUTREACH
Entity Type:Organization
Organization Name:JANE LOCKETT HARTMAN OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEMPEST
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-560-0727
Mailing Address - Street 1:801 S LEWIS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4882
Mailing Address - Country:US
Mailing Address - Phone:337-560-0727
Mailing Address - Fax:337-560-0728
Practice Address - Street 1:801 S LEWIS ST STE 3
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4882
Practice Address - Country:US
Practice Address - Phone:337-560-0727
Practice Address - Fax:337-560-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14007311Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility