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General NPI Number Information
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NPI Number | 1659623957
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Entity Type | Organization
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Legal Business Name | CADDO COUNCIL ON AGING, INC.
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 1700 BUCKNER ST SUITE 240
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City | SHREVEPORT
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State | LA
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Zip | 71101-4452
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Country | US
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Telephone | 318-676-7900
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Fax | 318-676-7911
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Provider Business Mailing Address
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Address Line | 1700 BUCKNER ST SUITE 240
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City | SHREVEPORT
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State | LA
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Zip | 71101-4452
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Country | US
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Telephone | 318-676-7900
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Fax | 318-676-7911
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARY ALICE ROUNTREE
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Credential |
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Telephone | 318-676-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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