1437378106 NPI number — HOLY ANGELS RESIDENTIAL FACILITY

Table of content: (NPI 1437378106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437378106 NPI number — HOLY ANGELS RESIDENTIAL FACILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLY ANGELS RESIDENTIAL FACILITY
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:
WILD OAK
Provider Other Organization Name Type Code:
3
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:
1437378106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10450 ELLERBE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-7712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-797-8500
Provider Business Mailing Address Fax Number:
318-798-0159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10450 ELLERBE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-7712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-797-8500
Provider Business Practice Location Address Fax Number:
318-798-0159
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORNE
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
LANDRY
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
318-797-8500

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346469012 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225256035 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528287299 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770750747 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992924658 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316165418 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497173090 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578014387 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861747636 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619196383 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639345853 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982823654 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164641833 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073732749 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184843849 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1437378106 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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