Healthcare Provider Details

I. General information

NPI: 1750560223
Provider Name (Legal Business Name): BUMGARNER CLIENT CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 S CARROLLTON AVE 200A-7
NEW ORLEANS LA
70119-6051
US

IV. Provider business mailing address

4640 S CARROLLTON AVE 200A-7
NEW ORLEANS LA
70119-6051
US

V. Phone/Fax

Practice location:
  • Phone: 504-322-7477
  • Fax: 504-322-7520
Mailing address:
  • Phone: 504-322-7477
  • Fax: 504-322-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number14036
License Number StateLA

VIII. Authorized Official

Name: MRS. CASSANDRA BUMGARNER
Title or Position: OWNER
Credential:
Phone: 504-812-7141