Healthcare Provider Details

I. General information

NPI: 1548993454
Provider Name (Legal Business Name): FLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 CHERRY ST
MAMOU LA
70554-2215
US

IV. Provider business mailing address

1905 N 7TH ST
WEST MONROE LA
71291-4415
US

V. Phone/Fax

Practice location:
  • Phone: 337-468-0347
  • Fax: 337-468-3389
Mailing address:
  • Phone: 318-812-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAWNE SMITH
Title or Position: MANAGER
Credential:
Phone: 318-812-2140