1104340686 NPI number — COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION

Table of content: (NPI 1104340686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104340686 NPI number — COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
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:
6
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:
1104340686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 BERT KOUNS INDUSTRIAL LOOP STE A
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:
71118-3351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-688-3350
Provider Business Mailing Address Fax Number:
318-688-3655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 STONECREEK DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONEWALL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71078-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-688-3350
Provider Business Practice Location Address Fax Number:
318-688-3655
Provider Enumeration Date:
07/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MOODY
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
318-688-3350

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com