Healthcare Provider Details

I. General information

NPI: 1245202373
Provider Name (Legal Business Name): HEALTH SERVICESGROUP OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA ST
BOGALUSA LA
70427-3729
US

IV. Provider business mailing address

433 PLAZA ST
BOGALUSA LA
70427-3729
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-1186
  • Fax:
Mailing address:
  • Phone: 985-732-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number418
License Number StateLA

VIII. Authorized Official

Name: CHERYL WALLACE
Title or Position: CFO
Credential:
Phone: 225-216-2299