MR. DERRICK DWAYNE BLACK (NPI# 1053817163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1053817163 |
Entity Type | Individual |
Full Name | MR. DERRICK DWAYNE BLACK |
Practice Address |
9051 Mansfield Rd Ste E3 Shreveport LA 71118-2680 |
Practice Telephone | 3187018216 |
Practice Fax Number | 3187163378 |
Mailing Telephone | 3184553433 |
Mailing Fax Number | 3187163378 |
Enumeration Date | 2018-04-05 |
Last Update Date | 2020-06-09 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 251E00000X | Home Health | LA | Agencies |
State | Issuer | Identifier | Type Code |
---|---|---|---|
LA | 822657580 | 05 |
Street Address |
9051 MANSFIELD RD STE E3 |
City | SHREVEPORT |
State | LA |
Zip Code | 71118-2680 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053936450 | Five Star Elite Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9051 Mansfield Rd Ste E3, Shreveport, LA 71118-2680 | 2020-06-11 |
1598380131 | Janice Leeshal Hurks | Nursing Home Administrator | 9051 Mansfield Rd Ste E3, Shreveport, LA 71118-2680 | 2020-06-09 |
1205450582 | Five Star Elite Home Health LLC | Home Health | 9051 Mansfield Rd Ste E3, Shreveport, LA 71118-2680 | 2020-06-03 |
1033752993 | Fset LLC | Non-emergency Medical Transport (VAN) | 9051 Mansfield Rd Ste E3, Shreveport, LA 71118-2680 | 2019-10-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720620784 | Wk Center for Pediatric Gastroenterology | Pediatrics | Wk Center for Pediatric Gastroenterology, 2530 Bert Kouns Industrial Loop, Ste 113, Shreveport, LA 71118 | 2019-10-11 |
1306302443 | Diamond Marie Willis | Case Manager/Care Coordinator | 9403 Mansfield Rd., Shreveport, LA 71118 | 2019-02-13 |
1194224469 | Latosa Hall | Case Manager/Care Coordinator | 9007 Letha Loop, Shreveport, LA 71118 | 2018-02-01 |
1902321623 | Bersheika Lashay Player | Counselor | 9403 Mansfield Road, Shreveport, LA 71118 | 2017-08-03 |
1518487149 | Clarke Jackson | Case Manager/Care Coordinator | 9730 Baird Rd Apt 2310, Shreveport, LA 71118 | 2017-06-24 |
1770010449 | Darrie'l Smith | Counselor | 2715 Mackey, Shreveport, LA 71118 | 2017-05-12 |
1760917041 | Delilah Wells | Case Manager/Care Coordinator | 9005 Walker Rd Apt 722, Shreveport, LA 71118 | 2017-04-25 |
1790229664 | We Care Transporttion Services LLC | Secured Medical Transport (VAN) | 2529 Summer Grove Dr, Shreveport, LA 71118 | 2016-12-13 |
1063955128 | Commanisha Smith | Social Worker | 2715 Mackey Place, Shreveport, LA 71118 | 2016-11-22 |
1023560802 | Yasmin Newman | Counselor | 9812 West Trails End, Shreveport, LA 71118 | 2016-10-27 |
Find all providers in zip 71118 |
Taxonomy Code | 251E00000X |
Grouping | Agencies |
Classification | Home Health |
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720626930 | Loyalty Healthcare Services | Home Health | 2800 Youree Dr Ste 131, Shreveport, LA 71104-3667 | 2019-12-18 |
1013412253 | We Care Sitting Services, LLC | Home Health | 2737 Mansfield Rd, Shreveport, LA 71103-3609 | 2018-03-29 |
1194220004 | Empress Devion Rushing | Home Health | 3012 Drexel St, Shreveport, LA 71108-2016 | 2018-03-24 |
1780105908 | Lhcg Cviii, LLC | Home Health | 1700 Buckner St Ste 200, Shreveport, LA 71101-4400 | 2017-06-28 |
1740713148 | Advance Mobile Dialysis Inc. | Home Health | 2054 Bermuda St, Shreveport, LA 71105-3802 | 2017-04-04 |
1811344914 | Professional Sitter Services | Home Health | 708 Milam St, Suite 202, Shreveport, LA 71101-5499 | 2016-05-18 |
1275989709 | Rock Bridge Training Institute LLC | Home Health | 200 N Thomas Dr Ste 14, Shreveport, LA 71107-6555 | 2016-05-13 |
1063800068 | Humble Heed Home Health Care Services | Home Health | 2701 Stanberry Dr, Shreveport, LA 71118-3252 | 2014-12-30 |
1750705299 | Butler Homecare Services, LLC | Home Health | 2800 Youree Dr Ste 205, Shreveport, LA 71104-3667 | 2014-02-04 |
1306181680 | Companion Home Services, LLC | Home Health | 668 Jordan, Suite B, Shreveport, LA 71101-4760 | 2012-11-28 |
Find all providers in SHREVEPORT |
City | SHREVEPORT |
Zip Code | 71118 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.