Provider Demographics
NPI:1013350180
Name:CHOICES OF LOUISIANA AT NORTHSHORE LLC
Entity Type:Organization
Organization Name:CHOICES OF LOUISIANA AT NORTHSHORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-450-3340
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:BRITTANY
Mailing Address - State:LA
Mailing Address - Zip Code:70718-0310
Mailing Address - Country:US
Mailing Address - Phone:225-450-3340
Mailing Address - Fax:225-450-6473
Practice Address - Street 1:615 PRIDE DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-9523
Practice Address - Country:US
Practice Address - Phone:985-419-1666
Practice Address - Fax:985-429-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASA0011074261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone