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Organization

GRACEFULLY YOURS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTY MIMS LPN (OWNER)
(318) 464-1989
Entity
Organization

Contact information

Practice address
959 TOWN NORTH DR, SHREVEPORT, LA 71107-2835
(318) 464-1989
Mailing address
959 TOWN NORTH DR, SHREVEPORT, LA 71107-2835
(318) 464-1989

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00000000000
N/A
Enumeration date
12/11/2020
Last updated
12/11/2020
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