Provider Demographics
NPI:1215312996
Name:MARY'S HEALTHCARE MINISTRIES, LLC
Entity type:Organization
Organization Name:MARY'S HEALTHCARE MINISTRIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:HIRCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-730-2336
Mailing Address - Street 1:40 HEYMAN LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3523
Mailing Address - Country:US
Mailing Address - Phone:318-730-2336
Mailing Address - Fax:
Practice Address - Street 1:40 HEYMAN LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3523
Practice Address - Country:US
Practice Address - Phone:318-730-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health