1316121916 NPI number — HEALTHY CHOICES, LLC

Table of content: (NPI 1316121916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316121916 NPI number — HEALTHY CHOICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY CHOICES, 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:
1316121916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4051 GROOM RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BAKER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70714-3566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-774-1993
Provider Business Mailing Address Fax Number:
225-774-3431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4615 MONKHOUSE DR
Provider Second Line Business Practice Location Address:
SUITE A-10
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71109-6119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-631-1113
Provider Business Practice Location Address Fax Number:
318-631-1173
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPEARS
Authorized Official First Name:
ASHTON
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
225-505-3285

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  12763 , 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)





Copyright © 2007-2024 www.npivalidator.com