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Organization

SOUTHEAST LOUISIANA AHEC FOUNDATION, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BRIAN PETER JAKES SR. BFA (CHIEF EXECUTIVE OFFICER)
(985) 345-1119
Entity
Organization

Contact information

Practice address
1302 J W DAVIS DR, HAMMOND, LA 70403-5914
(985) 345-1119
Mailing address
1302 J W DAVIS DR, HAMMOND, LA 70403-5914
(985) 345-1119

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
305S00000X
Point of Service
1175790
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
117590
LA
Enumeration date
03/17/2008
Last updated
03/17/2008
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