Provider Demographics
NPI:1972509271
Name:INTERIM HEALTHCARE OF SOUTHEAST LA INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTHEAST LA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:PREJEANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-834-9000
Mailing Address - Street 1:2424 EDENBORN AVE
Mailing Address - Street 2:STE 430
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1845
Mailing Address - Country:US
Mailing Address - Phone:504-834-9000
Mailing Address - Fax:504-834-9032
Practice Address - Street 1:2424 EDENBORN AVE
Practice Address - Street 2:STE 430
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1845
Practice Address - Country:US
Practice Address - Phone:504-834-9000
Practice Address - Fax:504-834-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA945251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1019740OtherUNITED HEALTH(MANDEVILLE)
72112OtherS.E. MEDICAL ALLIANCE
25135OtherCOVENTRY HEALTHCARE INC
CA1406686Medicaid
44054OtherGOVERNMENT EMPLOYEES HOSP
60054OtherAETNA HEALTH CARE
1018325OtherUNITED HEALTH (METAIRIE)
41170OtherHEALTH RISK MANAGEMENT
59333OtherPPO PLUS
72125OtherPEOPLE HEALTH NETWORK
36215OtherCENTRAL STATE PRO-PHCS
62308OtherCIGNA HEALTH PLANS
44054OtherGOVERNMENT EMPLOYEES HOSP