Organization
LAKELAND HEALTH CARE HOME AND COMMUNITY BASED WAIVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ALLEN MORAD (CEO)
(504) 891-8100
Entity
Organization
Contact information
Practice address
1206 J W DAVIS DR, SUITE 109, HAMMOND, LA 70403-5953
(504) 891-8100
(504) 891-8156
Mailing address
3525 PRYTANIA ST, SUITE 609, NEW ORLEANS, LA 70115-3500
(504) 891-8100
(504) 891-8156
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
PCA 7025
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011274
—
LA
Enumeration date
03/01/2007
Last updated
08/26/2008
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