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General NPI Number Information
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NPI Number | 1952350456
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Entity Type | Organization
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Legal Business Name | PRIMESTAR HOME HEALTH OF NWLA INC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 303 GREEN ST
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City | MINDEN
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State | LA
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Zip | 71055-3320
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Country | US
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Telephone | 318-259-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 DOCTORS DRIVE
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City | BOSSIER CITY
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State | LA
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Zip | 71111
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Country | US
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Telephone | 318-259-1410
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Fax | 318-532-6088
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER/PARTNER
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Name | MRS. TIFFANY ANNE CASTLEMAN
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Credential | RN, HCS-C
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Telephone | 318-259-1410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 12232
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 438
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License Number State | LA
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