1194047308 NPI number — SOUTHERN BELLE GROUP INC

Table of content: JOSEPHINE NDUTA THUO NP (NPI 1104443613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194047308 NPI number — SOUTHERN BELLE GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN BELLE GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194047308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1631 ELYSIAN FIELDS AVE
Provider Second Line Business Mailing Address:
SUITE B106
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70117-8208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1631 ELYSIAN FIELDS AVE
Provider Second Line Business Practice Location Address:
SUITE B106
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70117-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-339-1149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WERNER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
504-339-1149

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  14301R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)