Provider Demographics
NPI:1265604672
Name:ANNETTE
Entity type:Organization
Organization Name:ANNETTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-274-6190
Mailing Address - Street 1:PO BOX 6041
Mailing Address - Street 2:143CYPROVE GROVE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174-6041
Mailing Address - Country:US
Mailing Address - Phone:504-274-6190
Mailing Address - Fax:504-333-6179
Practice Address - Street 1:143 CYPRESS GROVE CT
Practice Address - Street 2:143CYPRESS GROVE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8562
Practice Address - Country:US
Practice Address - Phone:504-274-6190
Practice Address - Fax:504-333-6179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TONKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness