Basic Information
| Provider Information | |||||||||
| NPI: | 1083836407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONTEMPORARY QUALITY CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N THOMAS DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184248345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 N THOMAS DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184248345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOWDEN | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | WASHINGTON | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8006710616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | AD0004980 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1145572 | 05 | LA | MEDICAID |