Provider Demographics
NPI:1366696098
Name:FAMILY HEALTH OF LOUISIANA, LLC
Entity type:Organization
Organization Name:FAMILY HEALTH OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-665-5149
Mailing Address - Street 1:1810 FLORIDA BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726
Mailing Address - Country:US
Mailing Address - Phone:225-665-5149
Mailing Address - Fax:225-667-1770
Practice Address - Street 1:8369 FLORIDA BLVD
Practice Address - Street 2:STE. 8
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7862
Practice Address - Country:US
Practice Address - Phone:225-665-5149
Practice Address - Fax:225-667-1770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PHYSICIANS ALLIANCE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-07
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1459607Medicaid
LA1941000Medicaid
LA5DM66Medicare PIN
LA1941000Medicaid
LA57910Medicare PIN