Healthcare Provider Details

I. General information

NPI: 1215155510
Provider Name (Legal Business Name): NORTHEAST LOUISIANA HEALTH SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 HUDSON CIR SUITE 3
MONROE LA
71201
US

IV. Provider business mailing address

1888 HUDSON CIR SUITE 3
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-1101
  • Fax: 318-329-1107
Mailing address:
  • Phone: 318-329-1101
  • Fax: 318-329-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL SHANE DAVIDSON
Title or Position: PRESIDENT
Credential: PARAMEDIC
Phone: 318-329-1101