Provider Demographics
NPI:1871725192
Name:DEPARTMENT OF HEALTH & HOSPITALS
Entity type:Organization
Organization Name:DEPARTMENT OF HEALTH & HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-676-5160
Mailing Address - Street 1:2924 KNIGHT ST
Mailing Address - Street 2:BUILDING III, 2ND FLOOR, SUITE 350
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2415
Mailing Address - Country:US
Mailing Address - Phone:318-862-3053
Mailing Address - Fax:318-862-3080
Practice Address - Street 1:2924 KNIGHT ST
Practice Address - Street 2:BUILDING III, 2ND FLOOR, SUITE 350
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-862-3053
Practice Address - Fax:318-862-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA105261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health