Organization
NORTHSHORE INCS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS TEDESCO (PROGRAM COORDINATOR)
(985) 639-1605
Entity
Organization
Contact information
Practice address
742 E I 10 SERVICE RD, SLIDELL, LA 70461-5518
(985) 649-1605
Mailing address
742 E I 10 SERVICE RD, SLIDELL, LA 70461-5518
(985) 649-1605
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
10386
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171956
—
LA
Enumeration date
04/20/2007
Last updated
08/22/2020
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