Healthcare Provider Details

I. General information

NPI: 1093765273
Provider Name (Legal Business Name): ENTRUM CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 HIGHWAY 157
HAUGHTON LA
71037-7647
US

IV. Provider business mailing address

6235 HIGHWAY 157 PO BOX 1265
HAUGHTON LA
71037-7647
US

V. Phone/Fax

Practice location:
  • Phone: 318-949-1828
  • Fax: 318-949-1825
Mailing address:
  • Phone: 318-949-1828
  • Fax: 318-949-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1621447
License Number StateLA

VIII. Authorized Official

Name: MS. MARIE FULLER
Title or Position: ADMINISTRATOR
Credential: CMA, MA, MBA
Phone: 318-949-1828