1639404825 NPI number — SPECIAL CARE SERVICES OF LOUISIANA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639404825 NPI number — SPECIAL CARE SERVICES OF LOUISIANA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL CARE SERVICES OF LOUISIANA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639404825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2142 ONEAL LN
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-756-4494
Provider Business Mailing Address Fax Number:
225-756-4495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 EE WALLACE BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERRIDAY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71334-2241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-757-0407
Provider Business Practice Location Address Fax Number:
318-757-0507
Provider Enumeration Date:
10/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROACH
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
225-278-8375

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  PCA 15314 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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