Provider Demographics
NPI:1255375978
Name:HELPING HANDS FOR COMMUNITY DEVELOPMENT, INC.
Entity type:Organization
Organization Name:HELPING HANDS FOR COMMUNITY DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:OBALETTE
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CAT
Authorized Official - Phone:318-227-1113
Mailing Address - Street 1:2405 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3019
Mailing Address - Country:US
Mailing Address - Phone:318-227-1113
Mailing Address - Fax:318-227-1119
Practice Address - Street 1:2405 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3019
Practice Address - Country:US
Practice Address - Phone:318-227-1113
Practice Address - Fax:318-227-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00194591103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548294Medicaid