Healthcare Provider Details

I. General information

NPI: 1801993274
Provider Name (Legal Business Name): LORIE WHITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5854 HIGHWAY 77
FORDOCHE LA
70732-0178
US

IV. Provider business mailing address

PO BOX 178
FORDOCHE LA
70732-0178
US

V. Phone/Fax

Practice location:
  • Phone: 225-637-2178
  • Fax: 225-637-2185
Mailing address:
  • Phone: 225-637-2178
  • Fax: 225-637-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number87198
License Number StateLA

VIII. Authorized Official

Name: LORIE WHITE
Title or Position: OWNER
Credential:
Phone: 225-637-2178