Provider Demographics
NPI:1760029540
Name:PATCHWORKS SERVICES LLC
Entity type:Organization
Organization Name:PATCHWORKS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARNELL
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-458-5235
Mailing Address - Street 1:8036 PARKER PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-9706
Mailing Address - Country:US
Mailing Address - Phone:318-458-5235
Mailing Address - Fax:
Practice Address - Street 1:1010 CRESWELL AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3918
Practice Address - Country:US
Practice Address - Phone:318-458-5235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty