=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619277290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2010
-----------------------------------------------------
Last Update Date | 10/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1495 GARDENA DR
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70122-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-284-5933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4333 SHREVEPORT HWY
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-3828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-6470
-----------------------------------------------------
Fax | 318-641-6282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.O.O.
-----------------------------------------------------
Name | MS. NICOLE HOWARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-445-6470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | 1670
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------