| NPI | 1902080146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WILLIAMS SIMMONS Program Administrator 225-803-8217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA PCA 14063) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2007-12-24 |