Basic Information
| Provider Information | |||||||||
| NPI: | 1659971133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | START CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 165 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703610165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853332018 | ||||||||
| FaxNumber: | 9858510162 | ||||||||
| Practice Location | |||||||||
| Address1: | 23251 S ROBIN ROAD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704487044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9859001626 | ||||||||
| FaxNumber: | 9852668371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROUSSARD | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | QA AND COMPLIANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9853332018 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | N | Hospital Units | Psychiatric Unit | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.