Northeast Delta Human Services Authority
Clinic/Center, Primary Care in Monroe, LA. Organization (NPI-2).
NPI number1124772009
StatusActive
Last updated in NPPESAug 30, 2023
Details
- NPI
- 1124772009
- Entity type
- Organization (NPI-2)
- Legal business name
- Northeast Delta Human Services Authority
- Organization subpart
- Yes
- Enumeration date
- Feb 9, 2022
- Certification date
- Aug 30, 2023
- Last updated
- Aug 30, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
| 363LF0000X | Nurse Practitioner, Family | – | – |
Other names
- Monroe Behavioral Health Clinic-Medical (Doing Business As)
Practice location
4800 S Grand StMonroe, LA 71202-6412
Phone 318-362-3339 · Fax 318-362-3336
Mailing address
4800 S Grand StMonroe, LA 71202-6412
Phone 318-362-3339 · Fax 318-362-3336
Authorized official
Octavia Green
Administrative Program Specialist B
3183623270
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All 9 Primary Care Clinic/Center providers in Monroe · All 4,700 providers in Monroe
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