Healthcare Provider Details

I. General information

NPI: 1033552385
Provider Name (Legal Business Name): BASTROP PEDIATRIC DAY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HALL ST
BASTROP LA
71220-4602
US

IV. Provider business mailing address

205 HALL ST
BASTROP LA
71220-4602
US

V. Phone/Fax

Practice location:
  • Phone: 318-281-8009
  • Fax: 318-281-2937
Mailing address:
  • Phone: 318-281-8009
  • Fax: 318-281-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE SMITH
Title or Position: ADMINISTRATOR/DON
Credential: RN
Phone: 318-355-3204