Provider Demographics
NPI:1154779874
Name:JENNINGS AMERICAN LEGION HOSPITAL INC
Entity type:Organization
Organization Name:JENNINGS AMERICAN LEGION HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-616-7000
Mailing Address - Street 1:1634 ELTON RD
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3614
Mailing Address - Country:US
Mailing Address - Phone:337-616-7000
Mailing Address - Fax:
Practice Address - Street 1:328 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:LAKE ARTHUR
Practice Address - State:LA
Practice Address - Zip Code:70549
Practice Address - Country:US
Practice Address - Phone:337-774-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR1300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
255643Medicare PIN