Healthcare Provider Details

I. General information

NPI: 1760690754
Provider Name (Legal Business Name): JASTAY ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N WASHINGTON ST
BASTROP LA
71220
US

IV. Provider business mailing address

117 N WASHINGTON ST
BASTROP LA
71220
US

V. Phone/Fax

Practice location:
  • Phone: 318-556-3378
  • Fax: 318-283-5200
Mailing address:
  • Phone: 318-556-3378
  • Fax: 318-283-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number10769
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number10768
License Number StateLA

VIII. Authorized Official

Name: MRS. CYNTHIA FAYE TAYLOR
Title or Position: OWNER
Credential:
Phone: 318-556-3378