Provider Demographics
NPI:1184746836
Name:IONA CENTER
Entity type:Organization
Organization Name:IONA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:GOMILA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:318-322-0198
Mailing Address - Street 1:1031 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3365
Mailing Address - Country:US
Mailing Address - Phone:318-322-0198
Mailing Address - Fax:
Practice Address - Street 1:1031 PARK AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3365
Practice Address - Country:US
Practice Address - Phone:318-322-0198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health