1255592796 NPI number — LIVING STONES EMPLOYMENT SERVICES,LLC

Table of content: (NPI 1255592796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255592796 NPI number — LIVING STONES EMPLOYMENT SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVING STONES EMPLOYMENT SERVICES,LLC
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:
1255592796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5803 15TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35020-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-458-4368
Provider Business Mailing Address Fax Number:
205-565-0325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2264 PLEASURE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70122-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-458-4368
Provider Business Practice Location Address Fax Number:
205-565-0325
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
RENARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
504-458-4368

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  9437 , 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)

  • Identifier: 1171778 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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