Healthcare Provider Details

I. General information

NPI: 1922384312
Provider Name (Legal Business Name): J. ALLEN INVESTMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2011
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42573 PLEASANT RIDGE ROAD EXT
PONCHATOULA LA
70454-4764
US

IV. Provider business mailing address

42573 PLEASANT RIDGE ROAD EXT
PONCHATOULA LA
70454-4764
US

V. Phone/Fax

Practice location:
  • Phone: 318-415-8872
  • Fax: 985-345-3060
Mailing address:
  • Phone: 318-415-8872
  • Fax: 985-345-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. JA'JUAN JOSEPH ALLEN
Title or Position: OWNER
Credential:
Phone: 318-415-8872