Healthcare Provider Details

I. General information

NPI: 1144422650
Provider Name (Legal Business Name): PANAKEIA HEALTH SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 HWY. 171 SOUTH
STONEWALL LA
71078
US

IV. Provider business mailing address

8921 MANSFIELD RD
SHREVEPORT LA
71118-2144
US

V. Phone/Fax

Practice location:
  • Phone: 318-925-6660
  • Fax: 318-925-6667
Mailing address:
  • Phone: 318-688-5416
  • Fax: 318-415-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. SURESH K DONEPUDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 318-688-5416