Organization
EPIPHANY HEALTHCARE OF HAMMOND
Active
Other names
Back 2 Health Walk-In Clinic, Epiphany Healthcare of Hammond
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER MOORE (CEO, EXECUTIVE DIRECTOR)
(985) 209-6571
Entity
Organization
Contact information
Practice address
11059 PHYLLISS LN, HAMMOND, LA 70401-1102
(985) 209-6571
Mailing address
11059 PHYLLISS LN, HAMMOND, LA 70401-1102
(985) 209-6571
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
2279H0200X
Home Health Registered Respiratory Therapist
—
—
251E00000X
Home Health Agency
Primary
—
—
405300000X
Prevention Professional
2203783830
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2203783830
—
LA
Enumeration date
07/20/2018
Last updated
09/24/2018
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