Provider Demographics
NPI:1871529289
Name:ELMWOOD PARK PSYCHIATRIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:ELMWOOD PARK PSYCHIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-838-9551
Mailing Address - Street 1:3525 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 728
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3629
Mailing Address - Country:US
Mailing Address - Phone:504-838-9551
Mailing Address - Fax:504-830-4575
Practice Address - Street 1:3525 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 728
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3629
Practice Address - Country:US
Practice Address - Phone:504-838-9551
Practice Address - Fax:504-830-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C636Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER