Provider Demographics
NPI:1265514020
Name:HEAL CORPORATION
Entity type:Organization
Organization Name:HEAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-239-2509
Mailing Address - Street 1:103 BELVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-2902
Mailing Address - Country:US
Mailing Address - Phone:337-239-5209
Mailing Address - Fax:337-239-9764
Practice Address - Street 1:103 BELVIEW RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2902
Practice Address - Country:US
Practice Address - Phone:337-239-5209
Practice Address - Fax:337-239-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29831223G0001X
LA50241223G0001X
LA23671223P0106X
LA53301223P0221X
LA50601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH6076OtherBC/BS OF LA
LA3147896OtherBC/BS OF TN
LA1880272Medicaid
LA808180OtherUNITED CONCORDIA