NPIMap

Organization Active NPI

Northeast Delta Human Services Authority

  • Primary Care Clinic/Center
  • Monroe, LA
National Provider Identifier
1124772009
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NORTHEAST DELTA HUMAN SERVICES AUTHORITY
Practice address
4800 S Grand St
Monroe, LA 71202-6412
Phone
(318) 362-3339
Fax
(318) 362-3336
NPI assigned
Feb 9, 2022
Organization subpart
Yes
Parent organization
NORTHEAST DELTA HUMAN SERVICES AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Octavia Green
Title
Administrative Program Specialist B
Phone
(318) 362-3270

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

4800 S Grand St
Monroe, LA 71202-6412

Mailing address

4800 S Grand St
Monroe, LA 71202-6412
Phone (318) 362-3339

Other names 1

  • MONROE BEHAVIORAL HEALTH CLINIC-MEDICAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150121001268 LA Part B Supplier - Clinic/Group Practice 2961726005 Receives reassigned benefits from 29 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallulah, LA; Winnsboro, LA; Ruston, LA; Monroe, LA; Columbia, LA; Bastrop, LA

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Northeast Delta Human Services Authority14 organizations share this tax ID, including this one
Part of
Northeast Delta Human Services Authority

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1124772009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026412",
            "telephone_number": "318-362-3339",
            "fax_number": "318-362-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026412",
            "telephone_number": "318-362-3339",
            "fax_number": "318-362-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DELTA HUMAN SERVICES AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST DELTA HUMAN SERVICES AUTHORITY",
        "enumeration_date": "2022-02-09",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "OCTAVIA",
        "authorized_official_title_or_position": "ADMINISTRATIVE PROGRAM SPECIALIST B",
        "authorized_official_telephone_number": "318-362-3270"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONROE BEHAVIORAL HEALTH CLINIC-MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MONROE BEHAVIORAL HEALTH CLINIC-MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.