Provider Demographics
NPI:1194813089
Name:SHANTI HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SHANTI HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-255-5141
Mailing Address - Street 1:1229 FARMERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3513
Mailing Address - Country:US
Mailing Address - Phone:318-255-5141
Mailing Address - Fax:
Practice Address - Street 1:1229 FARMERVILLE HWY
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3513
Practice Address - Country:US
Practice Address - Phone:318-255-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA918853377261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center