Provider Demographics
NPI:1316648314
Name:SHEPHERDS HEART
Entity type:Organization
Organization Name:SHEPHERDS HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:LASHAY
Authorized Official - Last Name:HOWARD-NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-560-5703
Mailing Address - Street 1:8885 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-8816
Mailing Address - Country:US
Mailing Address - Phone:318-560-5703
Mailing Address - Fax:
Practice Address - Street 1:7505 PINES RD STE 1180
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3924
Practice Address - Country:US
Practice Address - Phone:318-560-5703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management