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General NPI Number Information
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NPI Number | 1346416807
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Entity Type | Organization
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Legal Business Name | BROOKS PERSONAL CARE ATTENDANT SERVICE LLC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 9309 CROOKED CREEK DR
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City | SHREVEPORT
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State | LA
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Zip | 71118-4154
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Country | US
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Telephone | 318-687-4589
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Fax | 318-687-4640
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Provider Business Mailing Address
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Address Line | 9309 CROOKED CREEK DR
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City | SHREVEPORT
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State | LA
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Zip | 71118-4154
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Country | US
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Telephone | 318-687-4589
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Fax | 318-687-4640
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LINDA BROOKS
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Credential | SPEECH PATHOLOGIST
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Telephone | 318-687-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PCA11279
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License Number State | LA
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