1902889892 NPI number — WEST CARROLL HEALTH SYSTEMS LLC

Table of content: (NPI 1902889892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902889892 NPI number — WEST CARROLL HEALTH SYSTEMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST CARROLL HEALTH SYSTEMS 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:
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:
1902889892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 ROSS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK GROVE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71263-9798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-559-2296
Provider Business Mailing Address Fax Number:
318-559-6652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 HOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PROVIDENCE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71254-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-559-2296
Provider Business Practice Location Address Fax Number:
318-559-6652
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
DEWANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-428-3237

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 1446530 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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