Provider Demographics
NPI:1063234961
Name:SACKZY MEDICAL SERVICES
Entity type:Organization
Organization Name:SACKZY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-614-0879
Mailing Address - Street 1:13512 THOMASWOODS LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7353
Mailing Address - Country:US
Mailing Address - Phone:225-614-0879
Mailing Address - Fax:
Practice Address - Street 1:13512 THOMASWOODS LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7353
Practice Address - Country:US
Practice Address - Phone:225-614-0879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility