=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851067797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSE OF HELPING ANGELS SOBER LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2021
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 TAMPA ST
-----------------------------------------------------
City | TALLULAH
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71282-5040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-867-4512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1818 HIGHWAY 134
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71203-6774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-703-8288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARKITA WASHINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-703-8288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------