=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720591118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STICK WITH US L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2017
-----------------------------------------------------
Last Update Date | 11/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4535 BENNINGTON AVE UNIT 80057
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70898-5042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-222-4532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4535 BENNINGTON AVE UNIT 80057
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70898-5042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-222-4532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHLEBOTOMIST, CCMA
-----------------------------------------------------
Name | GLENDA ROBERT
-----------------------------------------------------
Credential | CMMA, PHLEBOTOMIST
-----------------------------------------------------
Telephone | 504-222-4532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------