1689186645 NPI number — APEX HOME HEALTH-SOUTH, LLC.

Table of content: (NPI 1689186645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689186645 NPI number — APEX HOME HEALTH-SOUTH, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX HOME HEALTH-SOUTH, 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:
1689186645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68425 HIGHWAY 59 STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-7753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-288-0034
Provider Business Mailing Address Fax Number:
985-288-5629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 DOMINICAN RD STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-288-0037
Provider Business Practice Location Address Fax Number:
985-288-5629
Provider Enumeration Date:
10/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
NATHANIEL
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
985-869-7838

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HH0001393 , 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: 12B12 . This is a "BLUE CROSS BLUE SHIELD LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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