Provider Demographics
NPI:1548620552
Name:MADE, LLC
Entity type:Organization
Organization Name:MADE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:AA, AAS, BA, MSW
Authorized Official - Phone:504-221-5003
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-0224
Mailing Address - Country:US
Mailing Address - Phone:504-221-5003
Mailing Address - Fax:
Practice Address - Street 1:5605 6TH ST
Practice Address - Street 2:APT B
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-3083
Practice Address - Country:US
Practice Address - Phone:504-221-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health