Provider Demographics
NPI:1902280506
Name:A MOMENT IN TIME PATIENT CARE SERVICES. LLC
Entity Type:Organization
Organization Name:A MOMENT IN TIME PATIENT CARE SERVICES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RT (MR) ARRT
Authorized Official - Phone:318-773-8643
Mailing Address - Street 1:9435 MANSFIELD RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3859
Mailing Address - Country:US
Mailing Address - Phone:318-773-8643
Mailing Address - Fax:318-925-3373
Practice Address - Street 1:3085 KEITHVILLE KINGSTON RD
Practice Address - Street 2:
Practice Address - City:KEITHVILLE
Practice Address - State:LA
Practice Address - Zip Code:71047-8360
Practice Address - Country:US
Practice Address - Phone:318-773-8643
Practice Address - Fax:318-925-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10616713#3CF52311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home