NPI: 1023075017
Provider Name: DEPARTMENT OF HEALTH & HOSPITAL
Former Legal Business Name: SHREVEPORT BEHAVIORAL HEALTH CLINIC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization
Specialization: Rehabilitation, Substance Use Disorder
CLIA Number: 19D0981499
Address:
1310 NORTH HEARNE AVENUE
SHREVEPORT, LA
ZIP 71107
Phone: (318) 632-2040
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DEPARTMENT OF HEALTH & HOSPITAL is a rehabilitation and substance use disorder clinic center in Shreveport, LA. DEPARTMENT OF HEALTH & HOSPITAL NPI is 1023075017. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Shreveport Behavioral Health Clinic.
The provider's business location address is:
1310 NORTH HEARNE AVENUE
SHREVEPORT, LA
ZIP 71107
Phone: (318) 632-2040
Fax: (318) 632-2073
The provider's authorized official is Allie D. Allen .
The authorized official title is Administrative Program Manager and has the following contact phone number (318) 676-5111.
The CLIA number assigned to this NPI record is 19D0981499 - other with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 4/26/2006 and was last updated on 2/23/2012.