=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770762932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSUNCE CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2007
-----------------------------------------------------
Last Update Date | 10/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7505 PINES RD SUITE 1104
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71129-3935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-671-1772
-----------------------------------------------------
Fax | 318-671-1774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7505 PINES RD SUITE 1104
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71129-3935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-671-1772
-----------------------------------------------------
Fax | 318-671-1774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. REPUNDA BALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-671-1772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 10737
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------