Provider Demographics
NPI:1972855518
Name:MVP HEALTH GROUP LLC
Entity Type:Organization
Organization Name:MVP HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DASPIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-250-4739
Mailing Address - Street 1:2851 JOHNSTON ST
Mailing Address - Street 2:137
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3243
Mailing Address - Country:US
Mailing Address - Phone:337-250-4739
Mailing Address - Fax:877-742-2417
Practice Address - Street 1:2112 N PARKERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2001
Practice Address - Country:US
Practice Address - Phone:337-250-4739
Practice Address - Fax:877-742-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15529253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2162411Medicaid
LA2162471Medicaid