1265514020 NPI number — HEAL CORPORATION

Table of content: (NPI 1265514020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265514020 NPI number — HEAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAL CORPORATION
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:
1265514020
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:
103 BELVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-2902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-239-5209
Provider Business Mailing Address Fax Number:
337-239-9764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 BELVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-239-5209
Provider Business Practice Location Address Fax Number:
337-239-9764
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENNESSEE
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DR.
Authorized Official Telephone Number:
337-239-2509

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2983 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223G0001X , with the licence number: 5024 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223P0106X , with the licence number: 2367 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223P0221X , with the licence number: 5330 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223X0400X , with the licence number: 5060 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: H6076 . This is a "BC/BS OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 3147896 . This is a "BC/BS OF TN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1880272 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 808180 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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