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General NPI Number Information
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NPI Number | 1124081831
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Entity Type | Organization
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Legal Business Name | MID- STATE HOME HEALTH AGENCY INC
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 710 VERSAILLES BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2351
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Country | US
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Telephone | 318-443-9739
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Fax | 318-443-9811
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Provider Business Mailing Address
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Address Line | 710 VERSAILLES BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2351
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Country | US
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Telephone | 318-443-9739
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Fax | 318-443-9811
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MARK A BROWN
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Credential | C.P.A
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Telephone | 318-443-9739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 354
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License Number State | LA
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