Healthcare Provider Details

I. General information

NPI: 1689328825
Provider Name (Legal Business Name): MILLS EXECUTIVE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 MACKEY PL STE 225C
SHREVEPORT LA
71118-2544
US

IV. Provider business mailing address

2715 MACKEY PL STE 225C
SHREVEPORT LA
71118-2544
US

V. Phone/Fax

Practice location:
  • Phone: 318-670-7779
  • Fax:
Mailing address:
  • Phone: 318-670-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROSALIND MILLS
Title or Position: MANAGER
Credential:
Phone: 318-670-7779