1265005458 NPI number — PURE HEART PROVIDER & SITTER SERVICES, LLC

Table of content: (NPI 1265005458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265005458 NPI number — PURE HEART PROVIDER & SITTER SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURE HEART PROVIDER & SITTER SERVICES, 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:
1265005458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29547 HWY 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT SULPHUR
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-417-4329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29547 HIGHWAY 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT SULPHUR
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70083-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-417-4329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
504-417-4329

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113866551 . This is a "CONTRACTOR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 11386651 . This is a "MILITARY HEALTHCARE PROVIDER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 11386651 . This is a "HOME HEALTHCARE AGENCY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com