Healthcare Provider Details

I. General information

NPI: 1467883181
Provider Name (Legal Business Name): CARING HANDS PEDIATRIC DAY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 PROFESSIONAL DR W
SHREVEPORT LA
71105-5624
US

IV. Provider business mailing address

1009 PROFESSIONAL DR W
SHREVEPORT LA
71105-5624
US

V. Phone/Fax

Practice location:
  • Phone: 318-213-1281
  • Fax: 318-213-1282
Mailing address:
  • Phone: 318-213-1281
  • Fax: 318-213-1282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM LEE CLARK
Title or Position: OWNER
Credential:
Phone: 318-213-1281