Provider Demographics
NPI:1912182734
Name:EXCEPTIONAL CLIENT CARE SERVICES
Entity Type:Organization
Organization Name:EXCEPTIONAL CLIENT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-2118
Mailing Address - Street 1:6007 FINANCIAL PLZ STE 5B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2675
Mailing Address - Country:US
Mailing Address - Phone:318-688-2118
Mailing Address - Fax:318-688-2013
Practice Address - Street 1:6007 FINANCIAL PLZ STE 5B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2675
Practice Address - Country:US
Practice Address - Phone:318-688-2118
Practice Address - Fax:318-688-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 11052251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1468061Medicaid