Provider Demographics
NPI:1841579133
Name:MATTERS OF THE HEART OF NORTH LOUISIANA, LLC
Entity Type:Organization
Organization Name:MATTERS OF THE HEART OF NORTH LOUISIANA, LLC
Other - Org Name:MATTERS OF THE HEART OF NORTH LOUISIANA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRASHEDA
Authorized Official - Middle Name:KONYA
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-377-2742
Mailing Address - Street 1:721 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055
Mailing Address - Country:US
Mailing Address - Phone:318-377-2742
Mailing Address - Fax:318-377-2743
Practice Address - Street 1:721 BROADWAY
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055
Practice Address - Country:US
Practice Address - Phone:318-377-2742
Practice Address - Fax:318-377-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5072261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center