Provider Demographics
NPI:1104410505
Name:NOAH'S ARK MULTI-SERVICE CENTER
Entity type:Organization
Organization Name:NOAH'S ARK MULTI-SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-271-9029
Mailing Address - Street 1:7418 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4612
Mailing Address - Country:US
Mailing Address - Phone:832-271-9029
Mailing Address - Fax:
Practice Address - Street 1:7418 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4612
Practice Address - Country:US
Practice Address - Phone:832-271-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)