Provider Demographics
NPI:1649657917
Name:ETHOS COORDINATED CARE SERVICES,LLC
Entity type:Organization
Organization Name:ETHOS COORDINATED CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-456-7098
Mailing Address - Street 1:1821 WOODDALE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1535
Mailing Address - Country:US
Mailing Address - Phone:225-802-0289
Mailing Address - Fax:
Practice Address - Street 1:4142 LASSEN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-5126
Practice Address - Country:US
Practice Address - Phone:225-802-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health