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General NPI Number Information
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NPI Number | 1679179808
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Entity Type | Organization
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Legal Business Name | 5-D LIFE INC.
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 3419 NW EVANGELINE TRWY # 337
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City | CARENCRO
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State | LA
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Zip | 70520-6241
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Country | US
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Telephone | 337-896-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 4308 LANDRY RD
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City | SCOTT
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State | LA
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Zip | 70583-5407
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Country | US
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Telephone | 337-534-5475
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER JACQUE DELANEY
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Credential |
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Telephone | 337-534-5475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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