Healthcare Provider Details

I. General information

NPI: 1679733836
Provider Name (Legal Business Name): ST. MATTHEW'S DIRECT CARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CENTENARY BLVD BLDG 1 SUITE 104
SHREVEPORT LA
71104-3356
US

IV. Provider business mailing address

2620 CENTENARY BLVD STE 104
SHREVEPORT LA
71104-3351
US

V. Phone/Fax

Practice location:
  • Phone: 318-213-2273
  • Fax: 318-213-2275
Mailing address:
  • Phone: 318-213-2273
  • Fax: 318-213-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J SNEED
Title or Position: CHIEF ADMINSTRATOR
Credential:
Phone: 318-213-2273