1609439884 NPI number — B & W HEALTHCARE, LLC

Table of content: (NPI 1609439884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609439884 NPI number — B & W HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B & W HEALTHCARE, 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:
FAMILY HEALTHCARE OF BEDICO, LLC
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:
1609439884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42378 OTT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70403-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-320-7156
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27455 HIGHWAY 22 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCHATOULA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70454-8107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-206-9877
Provider Business Practice Location Address Fax Number:
985-206-9875
Provider Enumeration Date:
04/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, MANAGER
Authorized Official Telephone Number:
985-320-7156

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2194089 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com