Provider Demographics
NPI:1972772218
Name:NEW EARTH, INC.
Entity type:Organization
Organization Name:NEW EARTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-563-4424
Mailing Address - Street 1:4332 JEANSONNE ST
Mailing Address - Street 2:
Mailing Address - City:HESSMER
Mailing Address - State:LA
Mailing Address - Zip Code:71341-4649
Mailing Address - Country:US
Mailing Address - Phone:318-563-4424
Mailing Address - Fax:318-563-4424
Practice Address - Street 1:4332 JEANSONNE ST
Practice Address - Street 2:
Practice Address - City:HESSMER
Practice Address - State:LA
Practice Address - Zip Code:71341-4649
Practice Address - Country:US
Practice Address - Phone:318-563-4424
Practice Address - Fax:318-563-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA280320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1715531Medicaid