Individual
RASBY MASON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4727 BROADWAY AVE, SHREVEPORT, LA 71109-6908
(318) 349-9394
(318) 626-7179
Mailing address
4727 BROADWAY AVE, SHREVEPORT, LA 71109-6908
(318) 349-9394
(318) 626-7179
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251T00000X
PACE Provider Organization
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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