Provider Demographics
NPI:1083743041
Name:AN ENDLESS LOVE HOME CARE, LLC
Entity Type:Organization
Organization Name:AN ENDLESS LOVE HOME CARE, LLC
Other - Org Name:NORTHWEST LA INCS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-636-0390
Mailing Address - Street 1:6259 TINKER STREET
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109
Mailing Address - Country:US
Mailing Address - Phone:318-636-0390
Mailing Address - Fax:318-635-3298
Practice Address - Street 1:6003 FINANCIAL PLZ
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2670
Practice Address - Country:US
Practice Address - Phone:318-636-0390
Practice Address - Fax:318-635-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X
LA11761305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1172260Medicaid