=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700352986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE HEALTHCARE STAFFING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2018
-----------------------------------------------------
Last Update Date | 10/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1731 MOELING ST
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-1757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-304-8308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1731 MOELING ST
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-1757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-304-8308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | LASHAWNA EASTON EDWARDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-304-8308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------