Provider Demographics
NPI:1457822751
Name:IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Entity type:Organization
Organization Name:IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPEC.
Authorized Official - Prefix:
Authorized Official - First Name:NIKYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-475-3100
Mailing Address - Street 1:2651 E NAPOLEON ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-3707
Mailing Address - Country:US
Mailing Address - Phone:337-475-3100
Mailing Address - Fax:
Practice Address - Street 1:2651 E NAPOLEON ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663
Practice Address - Country:US
Practice Address - Phone:337-475-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPERIAL CALCASIEU HUMAN SERVICES AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-12
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)