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NPI Code Detail

MEDICARE: DORETHEA HAYWOOD MHP

MEDICARE: DORETHEA HAYWOOD MHP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1790157782
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORETHEA HAYWOOD MHP
Provider Business Mailing Address
First Line : 109 YORKTOWN DR STE A
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3673
Country : US
Telephone Number : 318-542-4288
Fax Number : 318-704-6201
Provider Business Practice Location Address
First Line : 109 YORKTOWN DR STE A
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3673
Country : US
Telephone Number : 318-542-4288
Fax Number : 318-704-6201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2015
Last Update Date : 10/18/2018

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