Provider Demographics
NPI:1023347895
Name:CROWLEY PSYCHIATRIC HOSPITAL
Entity type:Organization
Organization Name:CROWLEY PSYCHIATRIC HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-785-8003
Mailing Address - Street 1:1526 N AVENUE G
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2413
Mailing Address - Country:US
Mailing Address - Phone:337-788-3380
Mailing Address - Fax:337-788-3382
Practice Address - Street 1:426 N AVENUE G
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4438
Practice Address - Country:US
Practice Address - Phone:337-785-8003
Practice Address - Fax:337-785-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA586283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4N931Medicare PIN