Provider Demographics
NPI:1124461082
Name:THE DIABETES CARE CENTER
Entity type:Organization
Organization Name:THE DIABETES CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:318-224-3044
Mailing Address - Street 1:823 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4911
Mailing Address - Country:US
Mailing Address - Phone:318-224-3044
Mailing Address - Fax:318-232-2978
Practice Address - Street 1:823 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4911
Practice Address - Country:US
Practice Address - Phone:318-224-3044
Practice Address - Fax:318-232-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2390133V00000X
LAAP06647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty