Basic Information
Provider Information | |||||||||
NPI: | 1972800415 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PEOPLE UNITED OF LOUISIANA LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PEOPLE UNITED OF LOUISIANA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2142 ONEAL LN | ||||||||
Address2: | STE 311 | ||||||||
City: | BATON ROUGE | ||||||||
State: | LA | ||||||||
PostalCode: | 708163205 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2252788375 | ||||||||
FaxNumber: | 2257564495 | ||||||||
Practice Location | |||||||||
Address1: | 1401 HUDSON LN | ||||||||
Address2: | STE 202 | ||||||||
City: | MONROE | ||||||||
State: | LA | ||||||||
PostalCode: | 712016068 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3183231300 | ||||||||
FaxNumber: | 3183231400 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/18/2011 | ||||||||
LastUpdateDate: | 02/18/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ROACH | ||||||||
AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 2252788375 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MBA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | CM 27048 | LA | Y |   | Agencies | Case Management |   |
No ID Information.