Provider Demographics
NPI:1275665887
Name:RED RIVER CENTER LLC
Entity Type:Organization
Organization Name:RED RIVER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:N F ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-747-1857
Mailing Address - Street 1:4820 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4562
Mailing Address - Country:US
Mailing Address - Phone:318-747-1857
Mailing Address - Fax:318-741-1259
Practice Address - Street 1:4820 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4562
Practice Address - Country:US
Practice Address - Phone:318-747-1857
Practice Address - Fax:318-741-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BN1400X
LA5309510002332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1620998Medicaid
LA1620998Medicaid