Basic Information
Provider Information | |||||||||
NPI: | 1356767719 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NO/AIDS TASK FORCE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CRESCENTCARE FAMILY CARE SERVICES CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1631 ELYSIAN FIELDS AVE | ||||||||
Address2: |   | ||||||||
City: | NEW ORLEANS | ||||||||
State: | LA | ||||||||
PostalCode: | 701178208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5048212601 | ||||||||
FaxNumber: | 5042673014 | ||||||||
Practice Location | |||||||||
Address1: | 4640 S CARROLLTON AVE | ||||||||
Address2: | SUITE 120 | ||||||||
City: | NEW ORLEANS | ||||||||
State: | LA | ||||||||
PostalCode: | 701196051 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5043780427 | ||||||||
FaxNumber: | 5043787042 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/10/2014 | ||||||||
LastUpdateDate: | 05/16/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PRINGLE | ||||||||
AuthorizedOfficialFirstName: | GIOVANNA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 5048212601 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NO/AIDS TASK FORCE | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/16/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
ID | Type | State | Issuer | Description | 2366823 | 05 | LA |   | MEDICAID | 191916 | 01 | LA | MEDICARE A | OTHER |