Healthcare Provider Details

I. General information

NPI: 1770146987
Provider Name (Legal Business Name): NORTH TANGI ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 NW CENTRAL AVE
AMITE LA
70422-5723
US

IV. Provider business mailing address

45246 MORRIS RD
HAMMOND LA
70401-7816
US

V. Phone/Fax

Practice location:
  • Phone: 985-247-2509
  • Fax: 985-247-2509
Mailing address:
  • Phone: 985-507-2573
  • Fax: 985-247-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRLEY D HENDRICKS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 985-507-2573