MEDICARE: ST. MATTHEW'S DIRECT CARE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	171W00000X	Contractor
3	251E00000X	Home Health Agency	15076	LA

General Provider Information

NPI Number	:	1578729208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MATTHEW'S DIRECT CARE SERVICE

Provider Business Mailing Address
First Line	:	2620 CENTENARY BLVD STE 104
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3351
Country	:	US
Telephone Number	:	318-213-2273
Fax Number	:	318-213-2275

Provider Business Practice Location Address
First Line	:	2620 CENTENARY BLVD
Second Line	:	BLDG 1 SUITE 104
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3356
Country	:	US
Telephone Number	:	318-213-2273
Fax Number	:	318-213-2275

Authorized Official
Title or Position	:	CHIEF ADMINISTRATOR
Name	:	MATTHEW J SNEED
Credential	:
Telephone Number	:	318-213-2273

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	02/23/2026

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