# OH PROJECT- NORTHSHORE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OHANA HEALTHCARE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700354453
- **Legal business name:** OHANA HEALTHCARE
- **Authorized official:** TYRONE LUSTER (OWNER)
- **Authorized official phone:** (901) 626-2129

## Contact information

- **Practice address:** 190 GREENBRIER BLVD STE 105, COVINGTON, LA 70433-7237
- **Practice address phone:** (985) 276-3040
- **Mailing address:** PO BOX 957, MADISONVILLE, LA 70447-0957

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/09/2018
- **Last updated:** 11/09/2018