1801135124 NPI number — GODBEY-CARE LLC

Table of content: (NPI 1801135124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801135124 NPI number — GODBEY-CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GODBEY-CARE 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:
1801135124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 AUDUBON BLVD
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:
70125-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-861-4123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3525 PRYTANIA ST
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-897-7845
Provider Business Practice Location Address Fax Number:
504-897-7879
Provider Enumeration Date:
02/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GODBEY
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
504-897-7845

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  15035R , 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: 1166073 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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