Healthcare Provider Details

I. General information

NPI: 1730237397
Provider Name (Legal Business Name): MARIE'S FAMILY HEALTHCARE & SITTER SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E CRAIG ST
TALLULAH LA
71282-3718
US

IV. Provider business mailing address

PO BOX 1404
TALLULAH LA
71284-1404
US

V. Phone/Fax

Practice location:
  • Phone: 318-574-9009
  • Fax: 318-574-9926
Mailing address:
  • Phone: 318-574-9009
  • Fax: 318-574-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number14056
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0006420
License Number StateLA

VIII. Authorized Official

Name: MS. MATILDA WATSON JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 318-574-9009