1639374614 NPI number — SHAYLEE CARES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639374614 NPI number — SHAYLEE CARES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAYLEE CARES, INC.
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:
1639374614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741879
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70174-1879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-398-4296
Provider Business Mailing Address Fax Number:
504-398-4297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 BELLE CHASSE HWY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TERRYTOWN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-398-4296
Provider Business Practice Location Address Fax Number:
504-398-4297
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY
Authorized Official First Name:
LA VERNE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
504-398-4296

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  RC 13006 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1108863 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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