National Provider Identifier Database

LISA C REARDON, M.ED – NPI #1407890130
Nursing Home Administrator

An individual, often licensed by the state, who is responsible for the management of a nursing home.


Contact Information

LISA C REARDON, M.ED
307 NORTH CASTLEMAN STREET
OAK GROVE, LA71263-0788
Phone: 318-428-3249
Fax: 318-428-7547
Website:
Specialty Taxonomy Code
* Nursing Home Administrator 376G00000X

* Indicates primary specialty

NPI Profile & details for LISA C REARDON

NPI Number 1407890130
Credentials M.ED
Entity Individual
Enumeration date 06/15/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor1 Not specified
Identifiers
  • LA License #: 1183
  • LA Medicaid: 1511595
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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