Provider Demographics
NPI:1376107854
Name:
Entity Type:Organization
Organization Name:
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:GOYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-5574
Mailing Address - Street 1:4129 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2718
Mailing Address - Country:US
Mailing Address - Phone:318-443-5574
Mailing Address - Fax:318-443-5512
Practice Address - Street 1:4129 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2718
Practice Address - Country:US
Practice Address - Phone:318-443-5574
Practice Address - Fax:318-443-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty