Provider Demographics
NPI:1659094472
Name:CARE PARTNERS OF SHREVEPORT-BOSSIER
Entity Type:Organization
Organization Name:CARE PARTNERS OF SHREVEPORT-BOSSIER
Other - Org Name:CARE PARTNERS OF SHREVEPORT-BOSSIER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-401-7218
Mailing Address - Street 1:9972 FREEDOMS WAY
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-9222
Mailing Address - Country:US
Mailing Address - Phone:318-401-7218
Mailing Address - Fax:
Practice Address - Street 1:7505 PINES RD STE 1100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3900
Practice Address - Country:US
Practice Address - Phone:318-401-7218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2305034Medicaid