Provider Demographics
NPI:1568608735
Name:COUNCIL FOR THE ADVANCEMENT OF SOCIAL SERVIES AND EDUCATION
Entity Type:Organization
Organization Name:COUNCIL FOR THE ADVANCEMENT OF SOCIAL SERVIES AND EDUCATION
Other - Org Name:COMMUNITY HEALTH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-3350
Mailing Address - Street 1:2120 BERT KOUNS LOOP
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-688-3350
Mailing Address - Fax:318-688-3655
Practice Address - Street 1:907 POLK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2520
Practice Address - Country:US
Practice Address - Phone:318-872-1015
Practice Address - Fax:318-872-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1310018Medicaid