Healthcare Provider Details

I. General information

NPI: 1780902353
Provider Name (Legal Business Name): HENDERSON CONSTRUCTION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W 70TH ST
SHREVEPORT LA
71106-3716
US

IV. Provider business mailing address

208 W 70TH ST
SHREVEPORT LA
71106-3716
US

V. Phone/Fax

Practice location:
  • Phone: 318-861-0512
  • Fax: 318-861-0513
Mailing address:
  • Phone: 318-861-0512
  • Fax: 318-861-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number171WH0202X
License Number StateLA

VIII. Authorized Official

Name: MRS. MADELINE MARIE HENDERSON
Title or Position: PRESIDENT
Credential: GENERAL CONTRACTOR
Phone: 318-861-0512