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General NPI Number Information
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NPI Number | 1548507304
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Entity Type | Organization
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Legal Business Name | PHOENIX RAISING VETERAN SERVICES INC.
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Dates
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Enumeration Date | 01/12/2013
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Last Update Date | 01/12/2013
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Provider Practice Location Address
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Address Line | 2000 CALIFORNIA AVE
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City | KENNER
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State | LA
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Zip | 70062-5837
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Country | US
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Telephone | 504-305-0934
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 CALIFORNIA AVENUE
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City | KENNER
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State | LA
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Zip | 70062
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Country | US
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Telephone | 504-305-0934
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DWIGHT SAVOIE
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Credential |
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Telephone | 504-305-0934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2203781259
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License Number State | LA
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