MEDICARE: LILLIE HAYES

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1619785649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIE HAYES

Provider Business Mailing Address
First Line	:	2532 EMERY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4318
Country	:	US
Telephone Number	:	318-344-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 FOREST OAK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71109-8317
Country	:	US
Telephone Number	:	318-344-4328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	12/23/2024

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Directions to “ LILLIE HAYES ” Practice Location

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