Organization
A&E ADVANTAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALVINA COLLINS MATHERNE MADS (ADMINISTRATION)
(985) 758-2394
Entity
Organization
Contact information
Practice address
107 WARREN DR, DES ALLEMANDS, LA 70030-3338
(985) 758-2394
(985) 758-3742
Mailing address
107 WARREN DR, DES ALLEMANDS, LA 70030-3338
(985) 758-2394
(985) 758-3742
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CM4890
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1621366
—
LA
Enumeration date
03/07/2007
Last updated
06/11/2008
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