Provider Demographics
NPI:1699738989
Name:TIMNATH CORPORATION
Entity type:Organization
Organization Name:TIMNATH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DURAL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:985-519-3759
Mailing Address - Street 1:PO BOX 62862
Mailing Address - Street 2:143 RIDGEWAY SUITE 232
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-2862
Mailing Address - Country:US
Mailing Address - Phone:985-519-3759
Mailing Address - Fax:337-365-6599
Practice Address - Street 1:143 RIDGEWAY DR
Practice Address - Street 2:SUITE 232
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3414
Practice Address - Country:US
Practice Address - Phone:985-519-3759
Practice Address - Fax:337-365-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CR84Medicare ID - Type UnspecifiedPROVIDER NUMBER
LA4H126CR84Medicare PIN