Basic Information
| Provider Information | |||||||||
| NPI: | 1922005842 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1 | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | LADY OF THE SEA GENERAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 200 W 134TH PL | ||||||||
| Address2: | |||||||||
| City: | CUT OFF | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703454143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856326401 | ||||||||
| FaxNumber: | 9856328513 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W 134TH PL | ||||||||
| Address2: | |||||||||
| City: | CUT OFF | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703454143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856326401 | ||||||||
| FaxNumber: | 9856328513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9856326401 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 176 | LA | N | Hospital Units | Rehabilitation Unit | 275N00000X | 176 | LA | N | Hospital Units | Medicare Defined Swing Bed Unit | 282NR1301X | 176 | LA | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 1720089 | 05 | LA | MEDICAID |