Healthcare Provider Details

I. General information

NPI: 1104289727
Provider Name (Legal Business Name): BY GODS GRACE SITTER SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 HAZLEWOOD DR
DENHAM SPRINGS LA
70726-6596
US

IV. Provider business mailing address

13132 HAZLEWOOD DR
DENHAM SPRINGS LA
70726-6596
US

V. Phone/Fax

Practice location:
  • Phone: 225-663-0288
  • Fax:
Mailing address:
  • Phone: 225-663-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL RENEE JOSEPH
Title or Position: GENERAL PARTNER
Credential:
Phone: 225-663-0288