Provider Demographics
NPI:1194871517
Name:JANE LOCKETT HARTMAN OUTREACH INC
Entity type:Organization
Organization Name:JANE LOCKETT HARTMAN OUTREACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEMPEST
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-395-0035
Mailing Address - Street 1:316 HWY 90 WEST
Mailing Address - Street 2:PLANE NORMAL SHOPPING CENTER
Mailing Address - City:PATTERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70392
Mailing Address - Country:US
Mailing Address - Phone:985-395-0035
Mailing Address - Fax:985-395-0032
Practice Address - Street 1:316 HWY 90 WEST
Practice Address - Street 2:PLANE NORMAL SHOPPING CENTER
Practice Address - City:PATTERSON
Practice Address - State:LA
Practice Address - Zip Code:70392
Practice Address - Country:US
Practice Address - Phone:985-395-0035
Practice Address - Fax:985-395-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA121903747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1147559Medicaid