=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093462616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCSPADDEN SENIOR RESIDENCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2022
-----------------------------------------------------
Last Update Date | 03/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817 AURORA AVE
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-766-7368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 HUNTER PL
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70001-6159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MEMBER
-----------------------------------------------------
Name | MR. EVAN MCSPADDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-717-9802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------