Provider Demographics
NPI:1174788798
Name:PROMISE HOSPITAL OF ASCENSION INC
Entity type:Organization
Organization Name:PROMISE HOSPITAL OF ASCENSION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AREA CEO VP
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-621-1241
Mailing Address - Street 1:615 EAST WORTHEY RD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4240
Mailing Address - Country:US
Mailing Address - Phone:225-621-1241
Mailing Address - Fax:225-621-1419
Practice Address - Street 1:615 EAST WORTHEY RD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4240
Practice Address - Country:US
Practice Address - Phone:225-621-1241
Practice Address - Fax:225-621-1419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMISE HEALTHCARE INC CORP OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA610282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1754439Medicaid
LA1748285Medicaid
192004Medicare UPIN