1174609721 NPI number — COUNCIL FOR THE ADVANCEMENT OF SOCIAL SERVICES AND EDUCATION

Table of content: (NPI 1174609721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174609721 NPI number — COUNCIL FOR THE ADVANCEMENT OF SOCIAL SERVICES AND EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL FOR THE ADVANCEMENT OF SOCIAL SERVICES 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:
CASSE COMMUNITY HEALTH INSTITUTE
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:
1174609721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 POLK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71052-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-872-1015
Provider Business Mailing Address Fax Number:
318-872-1055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 POLK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71052-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-872-1015
Provider Business Practice Location Address Fax Number:
318-872-1055
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANNON
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
318-872-1015

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1452769 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com