Basic Information
| Provider Information | |||||||||
| NPI: | 1689706574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VOLUNTEERS OF AMERICA OF NORTH LOUISIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 JORDAN ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182212669 | ||||||||
| FaxNumber: | 3184297502 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 JORDAN ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182212669 | ||||||||
| FaxNumber: | 3184297502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MULLINNIX | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CAO | ||||||||
| AuthorizedOfficialTelephone: | 3182212669 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311Z00000X | X | Nursing & Custodial Care Facilities | Custodial Care Facility | 311ZA0620X | X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
ID Information
| ID | Type | State | Issuer | Description | 1929018 | 05 | LA | MEDICAID |