Provider Demographics
NPI:1407853641
Name:CADDO HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CADDO HOME HEALTH SERVICES, INC.
Other - Org Name:PROFESSIONAL HOME HEALTH OF CADDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-448-0891
Mailing Address - Street 1:3601 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2121
Mailing Address - Country:US
Mailing Address - Phone:318-861-3900
Mailing Address - Fax:318-868-4888
Practice Address - Street 1:3601 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2121
Practice Address - Country:US
Practice Address - Phone:318-861-3900
Practice Address - Fax:318-868-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400203Medicaid
LA1400203Medicaid