Provider Demographics
NPI:1073790044
Name:GREATER NEW ORLEANS SUPPORTS AND SERVICES CENTER - SIL
Entity type:Organization
Organization Name:GREATER NEW ORLEANS SUPPORTS AND SERVICES CENTER - SIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:WAIVER SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-364-6640
Mailing Address - Street 1:4460 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3529
Mailing Address - Country:US
Mailing Address - Phone:504-364-6640
Mailing Address - Fax:504-364-6652
Practice Address - Street 1:4460 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3529
Practice Address - Country:US
Practice Address - Phone:504-364-6640
Practice Address - Fax:504-364-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8000320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1709930Medicaid