Provider Demographics
NPI:1780914671
Name:STEEPLE COMMUNITY ECONOMIC DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:STEEPLE COMMUNITY ECONOMIC DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-686-2525
Mailing Address - Street 1:6339 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2417
Mailing Address - Country:US
Mailing Address - Phone:318-686-2525
Mailing Address - Fax:318-686-9079
Practice Address - Street 1:6339 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2417
Practice Address - Country:US
Practice Address - Phone:318-686-2525
Practice Address - Fax:318-686-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)