Provider Demographics
NPI:1730889296
Name:ELAYN HUNT CORRECTIONAL CENTER
Entity type:Organization
Organization Name:ELAYN HUNT CORRECTIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-319-4546
Mailing Address - Street 1:6925 HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-4706
Mailing Address - Country:US
Mailing Address - Phone:225-319-4546
Mailing Address - Fax:225-319-4254
Practice Address - Street 1:6925 HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:SAINT GABRIEL
Practice Address - State:LA
Practice Address - Zip Code:70776-4706
Practice Address - Country:US
Practice Address - Phone:225-319-4546
Practice Address - Fax:225-319-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy