Provider Demographics
NPI:1245013432
Name:CHERISHED SOLES LLC
Entity type:Organization
Organization Name:CHERISHED SOLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELANN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:318-235-2875
Mailing Address - Street 1:116 JEROLD DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9718
Mailing Address - Country:US
Mailing Address - Phone:318-235-2875
Mailing Address - Fax:
Practice Address - Street 1:116 JEROLD DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-9718
Practice Address - Country:US
Practice Address - Phone:318-235-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric