Provider Demographics
NPI:1356463020
Name:KELLIES SITTING SERVICES, INC.
Entity Type:Organization
Organization Name:KELLIES SITTING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-793-8453
Mailing Address - Street 1:123 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:318-793-8453
Mailing Address - Fax:318-793-5378
Practice Address - Street 1:123 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:318-793-8453
Practice Address - Fax:318-793-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA10531302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1429236Medicaid