Healthcare Provider Details

I. General information

NPI: 1366557092
Provider Name (Legal Business Name): PROMISE PRIDE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 GROOM ROAD
BAKER LA
70714-3124
US

IV. Provider business mailing address

5100 GROOM ROAD
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 Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberPCA 12774
License Number StateLA

VIII. Authorized Official

Name: MRS. MARY E WHITE
Title or Position: PROGRAM DIRECTOR ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 225-774-3499