Provider Demographics
NPI:1295039337
Name:KELLIE'S SITTING SERVICES, INC
Entity Type:Organization
Organization Name:KELLIE'S SITTING SERVICES, INC
Other - Org Name:KELLIE'S VOCATIONAL SUPPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-793-8453
Mailing Address - Street 1:107 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:LA
Mailing Address - Zip Code:71409-9284
Mailing Address - Country:US
Mailing Address - Phone:318-793-2929
Mailing Address - Fax:318-793-2931
Practice Address - Street 1:107 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409-9284
Practice Address - Country:US
Practice Address - Phone:318-793-2929
Practice Address - Fax:318-793-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC 081610251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1612456Medicaid