Healthcare Provider Details

I. General information

NPI: 1861693020
Provider Name (Legal Business Name): QUALITY INDEPENDENT SERVICE COORDINATORS OF LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19226 N 5TH ST
COVINGTON LA
70433-9017
US

IV. Provider business mailing address

19226 N 5TH ST
COVINGTON LA
70433-9017
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-0400
  • Fax: 985-809-0455
Mailing address:
  • Phone: 985-809-0400
  • Fax: 985-809-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2337
License Number StateLA

VIII. Authorized Official

Name: MS. JANET T CONNELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 504-858-9370