Organization
MEMORIAL HOME AND COMMUNITY BASED WAIVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIGE ANN OKPALOBI (CFO)
(504) 243-1018
Entity
Organization
Contact information
Practice address
5640 READ BLVD, SUITE 670, NEW ORLEANS, LA 70127-3140
(504) 243-1018
(504) 243-1066
Mailing address
PO BOX 5610, SLIDELL, LA 70469-5610
(504) 243-1018
(504) 234-1066
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
10/22/2007
Last updated
08/06/2010
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