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General NPI Number Information
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NPI Number | 1194941518
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Entity Type | Organization
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Legal Business Name | ST. GENEVIVE HEALTH CARE SERVICES, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 6009 FINANCIAL PLZ STE 101
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City | SHREVEPORT
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State | LA
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Zip | 71129-2615
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Country | US
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Telephone | 318-221-2566
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 KNIGHT ST SUITE 123
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City | SHREVEPORT
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State | LA
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Zip | 71105-2507
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Country | US
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Telephone | 318-219-4101
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TINA GRAHAM
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Credential |
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Telephone | 318-219-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | PCA 11980
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License Number State | LA
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