Provider Demographics
NPI:1023482064
Name:ABSOULTE HEALTH INC
Entity type:Organization
Organization Name:ABSOULTE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARKETTER
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:504-228-0465
Mailing Address - Street 1:2104 CARMEL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1814
Mailing Address - Country:US
Mailing Address - Phone:504-228-0465
Mailing Address - Fax:
Practice Address - Street 1:560 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:985-652-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1166456Medicaid