Healthcare Provider Details

I. General information

NPI: 1043264351
Provider Name (Legal Business Name): NESS HEALTHCARE NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23515 HWY 190
MANDEVILLE LA
70448
US

IV. Provider business mailing address

23515 HWY 190
MANDEVILLE LA
70448
US

V. Phone/Fax

Practice location:
  • Phone: 847-452-4585
  • Fax: 985-626-6559
Mailing address:
  • Phone: 847-452-4585
  • Fax: 985-626-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number214
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TONY SHIR
Title or Position: PRESIDENT
Credential:
Phone: 847-452-4565