Healthcare Provider Details

I. General information

NPI: 1215195508
Provider Name (Legal Business Name): MATTERS OF THE HEART OF NORTH LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 BROADWAY
MINDEN LA
71055
US

IV. Provider business mailing address

721 BROADWAY
MINDEN LA
71055
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-3778
  • Fax: 318-377-3879
Mailing address:
  • Phone: 318-377-3778
  • Fax: 318-377-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRASHEDA KONYA TOLIVER
Title or Position: OWNER
Credential:
Phone: 318-377-3778