Provider Demographics
NPI:1467509232
Name:NORTHWEST LOUISIANA FAMILY CARE, LLC
Entity Type:Organization
Organization Name:NORTHWEST LOUISIANA FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:318-377-0587
Mailing Address - Street 1:2 MEDICAL PLAZA PL
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3330
Mailing Address - Country:US
Mailing Address - Phone:318-377-0587
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PLAZA PL
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3330
Practice Address - Country:US
Practice Address - Phone:318-377-0587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO 03674261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442429Medicaid
LAP43843Medicare UPIN
LA4C005CA47Medicare ID - Type Unspecified