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General NPI Number Information
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NPI Number | 1154516128
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Entity Type | Organization
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Legal Business Name | MY PURPOSE COMMUNITY SERVICE
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 1377 GAUSE BLVD W
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City | SLIDELL
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State | LA
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Zip | 70460-5765
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Country | US
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Telephone | 985-847-9485
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Fax |
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Provider Business Mailing Address
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Address Line | 1377 GAUSE BLVD W
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City | SLIDELL
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State | LA
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Zip | 70460-5765
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Country | US
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Telephone | 985-847-9485
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. EVANGELINA J USSIN
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Credential | BSW,MSW,RSW
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Telephone | 985-847-9485
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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 | 1356921
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License Number State | LA
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