Provider Demographics
NPI:1174291132
Name:EARLEY HEALTHCARE
Entity Type:Organization
Organization Name:EARLEY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEIFE
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-600-3456
Mailing Address - Street 1:903 WARREN DR STE B
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7158
Mailing Address - Country:US
Mailing Address - Phone:318-600-3456
Mailing Address - Fax:
Practice Address - Street 1:903 WARREN DR STE B
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7158
Practice Address - Country:US
Practice Address - Phone:318-600-3456
Practice Address - Fax:318-600-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center