Healthcare Provider Details

I. General information

NPI: 1427446046
Provider Name (Legal Business Name): DAISY RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 HIGHWAY 4
JONESBORO LA
71251-6909
US

IV. Provider business mailing address

PO BOX 9
QUITMAN LA
71268-0009
US

V. Phone/Fax

Practice location:
  • Phone: 318-439-1399
  • Fax: 855-334-8166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLMFT198
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC2361
License Number StateLA

VIII. Authorized Official

Name: MR. BART E LILES
Title or Position: OWNER
Credential:
Phone: 318-439-1399