| Fphsa Mandeville Clinic | |
|
900 Wilkinson St Mandeville LA 70448-3533 | |
| (985) 624-4450 | |
| (985) 624-4461 |
| Full Name | Fphsa Mandeville Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 900 Wilkinson St, Mandeville, Louisiana |
| Authorized Official Name and Position | Melanie Watkins (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9855434333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fphsa Mandeville Clinic 900 Wilkinson St Mandeville LA 70448-3533 Ph: (985) 624-4450 | Fphsa Mandeville Clinic 900 Wilkinson St Mandeville LA 70448-3533 Ph: (985) 624-4450 |
| NPI Number | 1154750644 |
|---|---|
| Provider Enumeration Date | 11/05/2013 |
| Last Update Date | 02/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154750644 | NPI | - | NPPES |
| 1710181 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 119 (Louisiana) | Primary |
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