Provider Demographics
NPI:1285761965
Name:VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP OF ENTERPRISE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-486-8674
Mailing Address - Street 1:4152 CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5941
Mailing Address - Country:US
Mailing Address - Phone:504-482-2130
Mailing Address - Fax:504-482-1922
Practice Address - Street 1:823 CARROLL ST STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5126
Practice Address - Country:US
Practice Address - Phone:985-674-5475
Practice Address - Fax:985-674-5475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1155811Medicaid
LA3231018Medicaid