Provider Demographics
NPI:1285957829
Name:IN HIS HANDS OF BR, LLC
Entity type:Organization
Organization Name:IN HIS HANDS OF BR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:225-485-9111
Mailing Address - Street 1:21745 SAMUELS RD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6817
Mailing Address - Country:US
Mailing Address - Phone:225-658-6860
Mailing Address - Fax:225-685-4625
Practice Address - Street 1:21745 SAMUELS RD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-6817
Practice Address - Country:US
Practice Address - Phone:225-658-6860
Practice Address - Fax:225-685-4625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IN HIS HANDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1817422343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1817422Medicaid