Basic Information
| Provider Information | |||||||||
| NPI: | 1548867229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEBLANC | ||||||||
| FirstName: | CHARE' | ||||||||
| MiddleName: | NARISSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2236 WOODMERE BLVD | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700582249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043578213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 931 WESTWOOD DR STE E | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700722400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043408880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2020 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.