Provider Demographics
NPI:1306800289
Name:DEPARTMENT OF HEALTH AND HOSPITALS
Entity type:Organization
Organization Name:DEPARTMENT OF HEALTH AND HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EGAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-487-5191
Mailing Address - Street 1:PO BOX 7473
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-7473
Mailing Address - Country:US
Mailing Address - Phone:318-488-6846
Mailing Address - Fax:318-488-6844
Practice Address - Street 1:242 WEST SHAMROCK
Practice Address - Street 2:UNIT 1
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-488-6846
Practice Address - Fax:318-488-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALAC 592101YA0400X
LALAC # 904101YA0400X
LALAC #713101YA0400X
LARAC #1340101YA0400X
LACAC #1330101YA0400X
LARSW # 74781041C0700X
LALMSW #48701041C0700X
LARN #055444163WA0400X
LALPN # 850513164W00000X
LAMD 017125207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG9759OtherBLUECROSS BLUESHILED
LAG9759OtherBLUECROSS BLUESHILED