Provider Demographics
NPI:1407430259
Name:ESSENTIAL HEALTH CARE FAMILY PRACTICE
Entity Type:Organization
Organization Name:ESSENTIAL HEALTH CARE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:122-593-9854
Mailing Address - Street 1:3265 JERSEY DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4205
Mailing Address - Country:US
Mailing Address - Phone:225-939-8543
Mailing Address - Fax:
Practice Address - Street 1:3265 JERSEY DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4205
Practice Address - Country:US
Practice Address - Phone:225-939-8543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty