Healthcare Provider Details

I. General information

NPI: 1275665887
Provider Name (Legal Business Name): RED RIVER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 MEDICAL DR
BOSSIER CITY LA
71112-4562
US

IV. Provider business mailing address

4820 MEDICAL DR
BOSSIER CITY LA
71112-4562
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-1857
  • Fax: 318-741-1259
Mailing address:
  • Phone: 318-747-1857
  • Fax: 318-741-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number5309510002
License Number StateLA

VIII. Authorized Official

Name: MR. JAMES L COLLINS
Title or Position: N F ADMINISTRATOR
Credential:
Phone: 318-747-1857