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General NPI Number Information
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NPI Number | 1316103062
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Entity Type | Organization
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Legal Business Name | NORTHEAST LOUISIANA HEALTH SOLUTIONS
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1812 GLENMAR AVE SUITE B
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City | MONROE
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State | LA
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Zip | 71201-4932
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Country | US
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Telephone | 318-329-1101
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Fax | 318-329-1107
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Provider Business Mailing Address
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Address Line | 1812 GLENMAR AVE SUITE B
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City | MONROE
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State | LA
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Zip | 71201-4932
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Country | US
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Telephone | 318-329-1101
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Fax | 318-329-1107
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MICHAEL S DAVIDSON
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Credential |
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Telephone | 318-329-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 2203782471
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 15073
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License Number State | LA
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