Provider Demographics
NPI:1437382645
Name:1-SOURCE CONTRACTORS,LLC
Entity Type:Organization
Organization Name:1-SOURCE CONTRACTORS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-452-8847
Mailing Address - Street 1:PO BOX 1315
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-1315
Mailing Address - Country:US
Mailing Address - Phone:504-452-8847
Mailing Address - Fax:504-227-0722
Practice Address - Street 1:1901 WESTBANK EXPY
Practice Address - Street 2:STE 600
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4366
Practice Address - Country:US
Practice Address - Phone:504-452-8847
Practice Address - Fax:504-227-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management