Provider Demographics
NPI:1770721730
Name:LOUISIANA RE-ENTRY & REHABILITATION SERVICES
Entity type:Organization
Organization Name:LOUISIANA RE-ENTRY & REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:DUVOR
Authorized Official - Last Name:STEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-595-5015
Mailing Address - Street 1:1628 CARONDELET STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4454
Mailing Address - Country:US
Mailing Address - Phone:504-595-5015
Mailing Address - Fax:504-595-5019
Practice Address - Street 1:1628 CARONDELET ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4454
Practice Address - Country:US
Practice Address - Phone:504-595-5015
Practice Address - Fax:504-595-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA406251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA653435OtherMHSD