Basic Information
| Provider Information | |||||||||
| NPI: | 1548224330 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEPT. OF HEALTH & HOSPITALS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RED RIVER TREATMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7118 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713060118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184846400 | ||||||||
| FaxNumber: | 3184875703 | ||||||||
| Practice Location | |||||||||
| Address1: | MEADOW LANE | ||||||||
| Address2: | C/O CENTRAL STATE HOSPITAL, UNIT 6, | ||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184846400 | ||||||||
| FaxNumber: | 3184875703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CANNELLA | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INPATIENT FACILITY MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3184846661 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LCSW, BACS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | 162 | LA | Y | Hospital Units | Rehabilitation, Substance Use Disorder Unit |
ID Information
| ID | Type | State | Issuer | Description | F0545 | 01 | LA | BLUE CROSS BLUE SHIELD | OTHER |