Provider Demographics
NPI:1982685228
Name:PSYCHCARE OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:PSYCHCARE OF LOUISIANA, LLC
Other - Org Name:SHIFA COMMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORELLA
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPA
Authorized Official - Phone:225-927-7878
Mailing Address - Street 1:7916 WRENWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1782
Mailing Address - Country:US
Mailing Address - Phone:225-927-7878
Mailing Address - Fax:225-927-7787
Practice Address - Street 1:6717 GOYA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2171
Practice Address - Country:US
Practice Address - Phone:225-924-9930
Practice Address - Fax:225-925-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA194673261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA194673Medicare PIN