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Organization
MEMORIAL HOME AND COMMUNITY BASED WAIVER
Active
Organization
MEMORIAL HOME AND COMMUNITY BASED WAIVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ALLEN MORAD (CEO)
(504) 243-1018
Entity
Organization
Contact information
Practice address
5640 READ BLVD, NEW ORLEANS, LA 70127-3140
(504) 243-1018
(504) 243-1066
Mailing address
PO BOX 5610, SLIDELL, LA 70469-5610
(504) 243-1018
(504) 243-1066
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
PCA 14033
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED FOR
—
LA
Enumeration date
02/12/2008
Last updated
08/06/2010
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