Organization
CENTRAL LA STATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIQUE ANTHONY (ACCOUNTANT SUPERVISOR 2)
(318) 484-6803
Entity
Organization
Contact information
Practice address
6250 ESLER FIELD RD, PINEVILLE, LA 71360
(318) 484-6200
Mailing address
PO BOX 5031, PINEVILLE, LA 71361-5031
(318) 484-6308
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1945889
—
LA
Enumeration date
03/09/2007
Last updated
05/13/2024
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