Provider Demographics
NPI:1215111448
Name:LASALLE KIDCARE
Entity type:Organization
Organization Name:LASALLE KIDCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:M
Authorized Official - Last Name:VEULEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-992-9200
Mailing Address - Street 1:PO BOX 2780
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-2780
Mailing Address - Country:US
Mailing Address - Phone:318-992-6988
Mailing Address - Fax:318-992-6989
Practice Address - Street 1:121 NINTH STREET
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342
Practice Address - Country:US
Practice Address - Phone:318-992-6988
Practice Address - Fax:318-992-6989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LASALLE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health