Provider Demographics
NPI:1801984190
Name:LAKELAND HEALTH CARE SERVICE INC.
Entity type:Organization
Organization Name:LAKELAND HEALTH CARE SERVICE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MORAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-891-8100
Mailing Address - Street 1:PO BOX 5610
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70469-5610
Mailing Address - Country:US
Mailing Address - Phone:504-891-8100
Mailing Address - Fax:504-891-8156
Practice Address - Street 1:1126 COMMERCIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5972
Practice Address - Country:US
Practice Address - Phone:985-542-3131
Practice Address - Fax:985-542-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1031251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1406759Medicaid
LA1031OtherSTATE LICENSE
LA197781Medicare PIN