Provider Demographics
NPI:1598864084
Name:CANON HEALTH CARE LLC-TLHC
Entity Type:Organization
Organization Name:CANON HEALTH CARE LLC-TLHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:K
Authorized Official - Last Name:AKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-669-3825
Mailing Address - Street 1:1221 S CLEARVIEW PKWY
Mailing Address - Street 2:4TH FL
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1011
Mailing Address - Country:US
Mailing Address - Phone:504-669-3825
Mailing Address - Fax:504-648-1297
Practice Address - Street 1:1221 S CLEARVIEW PKWY
Practice Address - Street 2:4TH FL
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1011
Practice Address - Country:US
Practice Address - Phone:504-669-3825
Practice Address - Fax:504-648-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA84-IA315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580457Medicaid
LA191555Medicare Oscar/Certification