Provider Demographics
NPI:1174589022
Name:DEPARTMENT OF HEALTH AND HOSPITALS
Entity type:Organization
Organization Name:DEPARTMENT OF HEALTH AND HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OAD/REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:JERRI
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:318-362-3270
Mailing Address - Street 1:320 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4539
Mailing Address - Country:US
Mailing Address - Phone:318-283-0868
Mailing Address - Fax:318-283-0875
Practice Address - Street 1:320 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4539
Practice Address - Country:US
Practice Address - Phone:318-283-0868
Practice Address - Fax:318-283-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARAC1081101YA0400X
LAMD014425261QM1300X
LALAC1076101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG3195OtherBCBS
LAG3195OtherBCBS