Provider Demographics
NPI:1700094471
Name:EASTERN LA. MENTAL HEALTH SYS
Entity Type:Organization
Organization Name:EASTERN LA. MENTAL HEALTH SYS
Other - Org Name:GREENWELL SPRINGS CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:225-634-0201
Mailing Address - Street 1:23260 GREENWELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-6031
Mailing Address - Country:US
Mailing Address - Phone:225-262-2441
Mailing Address - Fax:225-262-2435
Practice Address - Street 1:23260 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-6031
Practice Address - Country:US
Practice Address - Phone:225-262-2441
Practice Address - Fax:225-262-2435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN LA MENTAL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710016Medicaid
LA194008Medicare Oscar/Certification
LA5D456Medicare PIN