Provider Demographics
NPI:1255156113
Name:LAKE CRESCENT HEALTH LLC
Entity type:Organization
Organization Name:LAKE CRESCENT HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:504-319-6078
Mailing Address - Street 1:P.O. BOX 82
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778
Mailing Address - Country:US
Mailing Address - Phone:504-319-6078
Mailing Address - Fax:225-644-6013
Practice Address - Street 1:301 NORTH MAIN STREET
Practice Address - Street 2:SUITE 2200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801
Practice Address - Country:US
Practice Address - Phone:504-319-6078
Practice Address - Fax:225-644-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty