Organization Name: | CHOICES OF LOUISIANA @NORTHSHORE, LLC |
NPI Number: | 1013350180 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROYE THOMAS BROWN (DIRECTOR) |
Mailing Address: | 615 Pride Dr Hammond |
State: | LA US |
Postal Code: | 704019523 |
Phone Number: | 9854191666 |
Fax Number: | 9854298999 |
NPI Enumeration Date: | 04/09/2013 |
NPI Last Update Date: | 04/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM2800X |
License Number: | SA0011074 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Methadone Clinic |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |