Provider Demographics
NPI:1194770669
Name:BAYOU LA BATRE AREA HEALTH DEVELOPMENT BD.INC.
Entity type:Organization
Organization Name:BAYOU LA BATRE AREA HEALTH DEVELOPMENT BD.INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:251-824-2174
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:BAYOU LA BATRE
Mailing Address - State:AL
Mailing Address - Zip Code:36509-0769
Mailing Address - Country:US
Mailing Address - Phone:251-824-2347
Mailing Address - Fax:251-824-4337
Practice Address - Street 1:1340 NORTH WINTZELL AVE.
Practice Address - Street 2:
Practice Address - City:BAYOU LA BATRE
Practice Address - State:AL
Practice Address - Zip Code:36509
Practice Address - Country:US
Practice Address - Phone:251-824-2347
Practice Address - Fax:251-824-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2006-293261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherFEDERAL TAX ID