Provider Demographics
NPI:1255576427
Name:HOLISTIC EDUCATIONAL REHABILATION CENTER
Entity type:Organization
Organization Name:HOLISTIC EDUCATIONAL REHABILATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHUN
Authorized Official - Middle Name:SENELL
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:504-367-6630
Mailing Address - Street 1:2100 BELLE CHASSE HWY
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7119
Mailing Address - Country:US
Mailing Address - Phone:504-367-6630
Mailing Address - Fax:504-367-6601
Practice Address - Street 1:2100 BELLE CHASSE HWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7119
Practice Address - Country:US
Practice Address - Phone:504-367-6630
Practice Address - Fax:504-367-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1169846253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1169846Medicaid