1760789002 NPI number — DURDEN CONSULTING SERVICES OF LA, LLC

Table of content: (NPI 1760789002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760789002 NPI number — DURDEN CONSULTING SERVICES OF LA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURDEN CONSULTING SERVICES OF LA, 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:
1760789002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5910 GA HIGHWAY 21 S
Provider Second Line Business Mailing Address:
UNIT 6
Provider Business Mailing Address City Name:
RINCON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31326-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2323 BAINBRIDGE ST
Provider Second Line Business Practice Location Address:
STE B-7
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70062-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-455-2092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DURHAM
Authorized Official First Name:
KENNEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
478-455-2092

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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: NOT YET ISSUED , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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