Healthcare Provider Details

I. General information

NPI: 1417294497
Provider Name (Legal Business Name): TANSHI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 HIGHWAY 171
STONEWALL LA
71078-9594
US

IV. Provider business mailing address

1 LAKESHORE DR SUITE 1000
LAKE CHARLES LA
70629-0100
US

V. Phone/Fax

Practice location:
  • Phone: 337-721-1900
  • Fax: 337-721-1976
Mailing address:
  • Phone: 337-721-1900
  • Fax: 337-721-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DHANA L DONEPUDI
Title or Position: OWNER
Credential:
Phone: 337-721-1900