Provider Demographics
NPI:1457348336
Name:OUR LADY OF THE LAKE ASCENSION COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:OUR LADY OF THE LAKE ASCENSION COMMUNITY HOSPITAL, INC.
Other - Org Name:ST. ELIZABETH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEJEUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-647-5075
Mailing Address - Street 1:1125 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5004
Mailing Address - Country:US
Mailing Address - Phone:225-674-5075
Mailing Address - Fax:225-674-6066
Practice Address - Street 1:1125 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5004
Practice Address - Country:US
Practice Address - Phone:225-674-5075
Practice Address - Fax:225-674-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-S242Medicare ID - Type UnspecifiedPROVIDER NUMBER