Healthcare Provider Details

I. General information

NPI: 1104325125
Provider Name (Legal Business Name): CASSANDRA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/10/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MAGNOLIA ST
HOUMA LA
70360-6304
US

IV. Provider business mailing address

1301 YOUREE DR
SHREVEPORT LA
71101-5117
US

V. Phone/Fax

Practice location:
  • Phone: 985-951-4701
  • Fax:
Mailing address:
  • Phone: 318-675-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: