Active NPI
Southeast Louisiana Ahec Foundation, Inc
- Early Intervention Provider Agency
- Hammond, LA
National Provider Identifier
1245401306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Early Intervention Provider Agency
- Legal business name
- SOUTHEAST LOUISIANA AHEC FOUNDATION, INC
- Practice address
- 1302 J W Davis Dr
Hammond, LA 70403-5914 - Phone
- (985) 345-1119
- NPI assigned
- Mar 17, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Brian Peter Jakes Sr., BFA
- Title
- Chief Executive Officer
- Phone
- (985) 345-1119
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | Primary | ||
| Point of Service | 305S00000X | 1175790 | LA |
Addresses
Primary practice location
1302 J W Davis Dr
Hammond, LA 70403-5914
Mailing address
1302 J W Davis Dr
Hammond, LA 70403-5914
Phone (985) 345-1119
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117590 | Medicaid | LA |
National Provider Directory
National Provider Directory- Tax ID family
- Selahec
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Exclusive Provider Organization
- Hammond, LA
- NPI 1962520213
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205712000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1205712000000",
"number": "1245401306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 J W DAVIS DR",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704035914",
"telephone_number": "985-345-1119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 J W DAVIS DR",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704035914",
"telephone_number": "985-345-1119"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEAST LOUISIANA AHEC FOUNDATION, INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-03-17",
"last_updated": "2008-03-17",
"status": "A",
"authorized_official_last_name": "JAKES",
"authorized_official_first_name": "BRIAN",
"authorized_official_middle_name": "PETER",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "985-345-1119",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Sr.",
"authorized_official_credential": "BFA"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": null,
"license": null,
"primary": true
},
{
"code": "305S00000X",
"taxonomy_group": "",
"desc": "Point of Service",
"state": "LA",
"license": "1175790",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "117590",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hammond, LA
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems Pharmacy
- Southeast Family Medical Practice
- Southeast Louisiana Area Health Education Foundation, Inc.
- Southeast Louisiana Veterans Health Care System
- Southeast Menatal Health
- Southeast Mental Health LLC
- Southeastern Louisiana Univerisity
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.