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General NPI Number Information
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NPI Number | 1194813089
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Entity Type | Organization
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Legal Business Name | SHANTI HEALTH SERVICES LLC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1229 FARMERVILLE HWY
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City | RUSTON
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State | LA
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Zip | 71270-3513
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Country | US
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Telephone | 318-255-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 FARMERVILLE HWY
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City | RUSTON
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State | LA
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Zip | 71270-3513
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Country | US
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Telephone | 318-255-5141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHELYNA RICE
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Credential | NP
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Telephone | 318-255-5141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 918853377
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License Number State | LA
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