Healthcare Provider Details

I. General information

NPI: 1972855518
Provider Name (Legal Business Name): MVP HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 N PARKERSON AVE SUITE A
CROWLEY LA
70526-2001
US

IV. Provider business mailing address

2851 JOHNSTON ST 137
LAFAYETTE LA
70503-3243
US

V. Phone/Fax

Practice location:
  • Phone: 337-250-4739
  • Fax: 877-742-2417
Mailing address:
  • Phone: 337-250-4739
  • Fax: 877-742-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number15529
License Number StateLA

VIII. Authorized Official

Name: JENNIFER LYNN DASPIT
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-250-4739