Provider Demographics
NPI:1285854976
Name:GOD'S GIFT PROFESSIONAL CARE SERVICE
Entity Type:Organization
Organization Name:GOD'S GIFT PROFESSIONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SCHAWANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-629-5391
Mailing Address - Street 1:2620 CENTENARY BLVD
Mailing Address - Street 2:BLDG 1 SUITE 104
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3356
Mailing Address - Country:US
Mailing Address - Phone:318-629-5391
Mailing Address - Fax:318-629-5392
Practice Address - Street 1:2620 CENTENARY BLVD
Practice Address - Street 2:BLDG 1 SUITE 104
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3356
Practice Address - Country:US
Practice Address - Phone:318-629-5391
Practice Address - Fax:318-629-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 10506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471330Medicaid