Healthcare Provider Details

I. General information

NPI: 1982834107
Provider Name (Legal Business Name): GODDESS PATIENT CARE ADVOCATES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 VIC A. PITRE DR.
WESTWEGO LA
70094
US

IV. Provider business mailing address

509 VIC A. PITRE DR.
WESTWEGO LA
70094
US

V. Phone/Fax

Practice location:
  • Phone: 504-340-1124
  • Fax:
Mailing address:
  • Phone: 504-340-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. YOUCOSTA CONCHETTA PRINCE
Title or Position: OWNER/ADMINISTRATOR/MANAGER
Credential:
Phone: 504-340-1124