Provider Demographics
NPI:1326887894
Name:COUSHATTA TRIBE OF LOUISIANA
Entity type:Organization
Organization Name:COUSHATTA TRIBE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-584-1439
Mailing Address - Street 1:2003 C C BEL ROAD
Mailing Address - Street 2:
Mailing Address - City:ELTON
Mailing Address - State:LA
Mailing Address - Zip Code:70532
Mailing Address - Country:US
Mailing Address - Phone:337-584-1439
Mailing Address - Fax:337-584-1473
Practice Address - Street 1:287 PANTHER TRAIL
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648
Practice Address - Country:US
Practice Address - Phone:337-738-4170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUSHATTA TRIBE OF LOUISIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy