Provider Demographics
NPI:1881449676
Name:LA FAMILIA DE VILLAGE
Entity type:Organization
Organization Name:LA FAMILIA DE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHONELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:504-259-5407
Mailing Address - Street 1:1411 S WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6223
Mailing Address - Country:US
Mailing Address - Phone:504-259-5407
Mailing Address - Fax:504-389-6219
Practice Address - Street 1:7809 AIRLINE DR STE 200A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6440
Practice Address - Country:US
Practice Address - Phone:504-333-2206
Practice Address - Fax:504-389-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty