1174777288 NPI number — SPECIAL CARE SERVICES OF LOUISIANA, INC

Table of content: (NPI 1174777288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174777288 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:
1174777288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2008
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:
225-278-8375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST JOSEPH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-766-9396
Provider Business Practice Location Address Fax Number:
318-766-9499
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  14025 , 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)

  • Identifier: 1408719 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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