Provider Demographics
NPI:1801840210
Name:RURAL HEALTH CARE DEVELOPMENT CORPORATION LLC
Entity type:Organization
Organization Name:RURAL HEALTH CARE DEVELOPMENT CORPORATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-768-1995
Mailing Address - Street 1:4700 WICHERS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3054
Mailing Address - Country:US
Mailing Address - Phone:985-768-1995
Mailing Address - Fax:504-340-4636
Practice Address - Street 1:4700 WICHERS DR STE 206
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3054
Practice Address - Country:US
Practice Address - Phone:985-768-1995
Practice Address - Fax:504-340-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU05Medicare UPIN