Basic Information
| Provider Information | |||||||||
| NPI: | 1972743078 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIMS SOCIAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1525 | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700731525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043629010 | ||||||||
| FaxNumber: | 5043629070 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 BELLE CHASSE HWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700536758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043629010 | ||||||||
| FaxNumber: | 5043629070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2009 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | SIMS | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5043629010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | LCSW-BACS | ||||||||
| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7570 | LA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251S00000X | N | Agencies | Community/Behavioral Health | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 4H600 | 01 | LA | MEDICARE | OTHER | 2185187 | 05 | LA | MEDICAID |