Organization Name: | ABC SHREVEPORT LLC |
NPI Number: | 1063899037 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEITH HAYDEN CARTER (CEO) |
Mailing Address: | 4700 Line Ave Suite 111 Shreveport |
State: | LA US |
Postal Code: | 711061533 |
Phone Number: | 3184245300 |
Fax Number: | 3184245513 |
NPI Enumeration Date: | 04/29/2015 |
NPI Last Update Date: | 04/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |