Healthcare Provider Details

I. General information

NPI: 1316129828
Provider Name (Legal Business Name): PROMISE PRIDE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 GROOM RD
BAKER LA
70714-3124
US

IV. Provider business mailing address

5100 GROOM RD
BAKER LA
70714-3124
US

V. Phone/Fax

Practice location:
  • Phone: 225-774-3385
  • Fax: 225-774-7381
Mailing address:
  • Phone: 225-774-3385
  • Fax: 225-774-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADHC 5039
License Number StateLA

VIII. Authorized Official

Name: MRS. MARY E. WHITE
Title or Position: PROGRAM DIRECTOR/ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 225-774-3385