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General NPI Number Information
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NPI Number | 1740713700
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Entity Type | Organization
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Legal Business Name | HELPING THE SICK N SHUT IN OF NOTH LA
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 5342 BROADWAY AVE
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City | SHREVEPORT
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State | LA
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Zip | 71109-7210
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Country | US
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Telephone | 318-946-2487
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Fax |
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Provider Business Mailing Address
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Address Line | 5342 BROADWAY AVE
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City | SHREVEPORT
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State | LA
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Zip | 71109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HOME HEALTH
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Name | MISS LAKEISHIA KAWON JOHNSON
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Credential | L.V.N
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Telephone | 318-946-2487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 3747P180X
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License Number State | LA
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