Healthcare Provider Details

I. General information

NPI: 1104140565
Provider Name (Legal Business Name): PRISM II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 KEYSER AVE
NATCHITOCHES LA
71457-6037
US

IV. Provider business mailing address

740 KEYSER AVE
NATCHITOCHES LA
71457-6037
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-0088
  • Fax: 318-214-9009
Mailing address:
  • Phone: 318-214-0088
  • Fax: 318-214-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE BIENVENU
Title or Position: PARTNER
Credential: OT
Phone: 318-481-2148