=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104179316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALVEZ PERSONAL CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2012
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1407 PIETY ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70117-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-948-6984
-----------------------------------------------------
Fax | 504-948-4456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1407 PIETY ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70117-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-948-6984
-----------------------------------------------------
Fax | 504-948-4456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. THERESA PETERS FISHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-948-6984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 2203781057
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------