Provider Demographics
NPI:1740713700
Name:HELPING THE SICK N SHUT IN OF NOTH LA
Entity type:Organization
Organization Name:HELPING THE SICK N SHUT IN OF NOTH LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAKEISHIA
Authorized Official - Middle Name:KAWON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:318-946-2487
Mailing Address - Street 1:5342 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5342 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-7210
Practice Address - Country:US
Practice Address - Phone:318-946-2487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747P180X320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1144673963OtherRED# 212185120518
LA1604091000OtherMEDICAL ASSISTANT ON THE JOB TRAINING