Provider Demographics
NPI:1457703654
Name:AMENA HEALTHCARE GROUP
Entity Type:Organization
Organization Name:AMENA HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER CERTIFIE MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-687-2001
Mailing Address - Street 1:5253 DIJON DR
Mailing Address - Street 2:STE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4393
Mailing Address - Country:US
Mailing Address - Phone:225-687-2001
Mailing Address - Fax:225-687-9519
Practice Address - Street 1:5253 DIJON DR
Practice Address - Street 2:STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4393
Practice Address - Country:US
Practice Address - Phone:225-687-2001
Practice Address - Fax:225-687-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty