Healthcare Provider Details

I. General information

NPI: 1851537930
Provider Name (Legal Business Name): RURAL HEALTHCARE DEVELOPERS OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10080 GULF HWY
LAKE CHARLES LA
70607-8672
US

IV. Provider business mailing address

10080 GULF HWY
LAKE CHARLES LA
70607-8672
US

V. Phone/Fax

Practice location:
  • Phone: 337-905-4111
  • Fax: 337-905-5711
Mailing address:
  • Phone: 337-905-4111
  • Fax: 337-905-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number534RHC-1
License Number StateLA

VIII. Authorized Official

Name: RAY SHOEMAKER
Title or Position: CEO
Credential:
Phone: 662-321-1155