Healthcare Provider Details

I. General information

NPI: 1891952297
Provider Name (Legal Business Name): WONDER WORKING POWER HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 SGT ALFRED STE 7
SLIDELL LA
70458-4012
US

IV. Provider business mailing address

2767 SGT ALFRED STE 7
SLIDELL LA
70458-4012
US

V. Phone/Fax

Practice location:
  • Phone: 985-649-8449
  • Fax: 985-649-8149
Mailing address:
  • Phone: 985-649-8449
  • Fax: 985-649-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. TARYN EDWARDS
Title or Position: ONWER
Credential: ETC
Phone: 985-649-8449