Provider Demographics
NPI:1801031133
Name:ST. MARY PARISH GOVERNMENT/FAIRVIEW TREATMENT CENTE
Entity type:Organization
Organization Name:ST. MARY PARISH GOVERNMENT/FAIRVIEW TREATMENT CENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEESE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC/CCS
Authorized Official - Phone:985-395-6750
Mailing Address - Street 1:1101 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-5933
Mailing Address - Country:US
Mailing Address - Phone:985-395-6750
Mailing Address - Fax:985-395-6794
Practice Address - Street 1:1101 SOUTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-5933
Practice Address - Country:US
Practice Address - Phone:985-395-6750
Practice Address - Fax:985-395-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility