Organization
DEPARTMENT OF HEALTH & HOSPITAL
Active
Other names
FPHSA/Hammond A D C
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE J. WALLACE JR. GSW (CLINIC MANAGER)
(985) 543-4070
Entity
Organization
Contact information
Practice address
1920 FLORIDA AVE SW, DENHAM SPRINGS, LA 70726-4970
(225) 665-0473
(225) 665-0283
Mailing address
1920 FLORIDA AVE SW, DENHAM SPRINGS, LA 70726-4970
(225) 665-0473
(225) 665-0283
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
395A
LA
Other
Enumeration date
04/27/2009
Last updated
04/27/2009
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