Basic Information
| Provider Information | |||||||||
| NPI: | 1407078934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAMI NEW ORLEANS, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | FRIENDS ALLIANCE FOR THE MENTALLY ILL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1538 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048962345 | ||||||||
| FaxNumber: | 5048962240 | ||||||||
| Practice Location | |||||||||
| Address1: | 2051 EIGHTH ST | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043681944 | ||||||||
| FaxNumber: | 5043689784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 04/26/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROMBACK | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5048962345 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | ADC2583 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1926221 | 05 | LA | MEDICAID |