Provider Demographics
NPI:1831692227
Name:LEISURE COMMUNITY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:LEISURE COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-402-4155
Mailing Address - Street 1:16430 KEYSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-6190
Mailing Address - Country:US
Mailing Address - Phone:225-773-4156
Mailing Address - Fax:
Practice Address - Street 1:16270 AIRLINE HWY STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4589
Practice Address - Country:US
Practice Address - Phone:225-773-4156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health