Provider Demographics
NPI:1952467946
Name:FANTASTIC HEALTHCARE LLC
Entity Type:Organization
Organization Name:FANTASTIC HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:EKECHEKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-254-2924
Mailing Address - Street 1:16500 CHEF MENTEUR HWY.
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129
Mailing Address - Country:US
Mailing Address - Phone:504-254-2924
Mailing Address - Fax:504-254-2925
Practice Address - Street 1:16500 CHEF MENTEUR HWY.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2432
Practice Address - Country:US
Practice Address - Phone:504-254-2924
Practice Address - Fax:504-254-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4542817-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621331Medicaid
LA5407230001Medicare ID - Type Unspecified
LA1621331Medicaid