Provider Demographics
NPI:1457720161
Name:CONTEMPORARY FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:CONTEMPORARY FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-241-7751
Mailing Address - Street 1:7921 BULLARD AVE
Mailing Address - Street 2:SUITE #1C
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1197
Mailing Address - Country:US
Mailing Address - Phone:504-241-7752
Mailing Address - Fax:504-241-7753
Practice Address - Street 1:7921 BULLARD AVE
Practice Address - Street 2:SUITE #1C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1197
Practice Address - Country:US
Practice Address - Phone:504-241-7752
Practice Address - Fax:504-241-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA849251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1406562Medicaid
LA197754Medicare UPIN