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General NPI Number Information
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NPI Number | 1962681544
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Entity Type | Organization
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Legal Business Name | JANE LOCKETT HARTMAN OUTREACH
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 801 S LEWIS ST STE 3
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City | NEW IBERIA
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State | LA
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Zip | 70560-4882
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Country | US
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Telephone | 337-560-0727
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Fax | 337-560-0728
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Provider Business Mailing Address
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Address Line | 801 S LEWIS ST STE 3
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City | NEW IBERIA
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State | LA
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Zip | 70560-4882
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Country | US
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Telephone | 337-560-0727
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Fax | 337-560-0728
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Authorized Official
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Title or Position | OWNER
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Name | MS. TEMPEST JACKSON
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Credential |
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Telephone | 337-560-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 14007
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 14007
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License Number State | LA
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