1215396775 NPI number — HEART 2 HEART CARE CLINIC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215396775 NPI number — HEART 2 HEART CARE CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART 2 HEART CARE CLINIC, 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:
1215396775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1984 WOODDALE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-300-6116
Provider Business Mailing Address Fax Number:
877-755-3963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1984 WOODDALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-803-9230
Provider Business Practice Location Address Fax Number:
777-553-9638
Provider Enumeration Date:
02/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BURRELL
Authorized Official First Name:
SHETILA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
225-300-6010

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  AP007758 , 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)





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