Healthcare Provider Details

I. General information

NPI: 1487969697
Provider Name (Legal Business Name): REGIONAL PCA SERVICES - BATON ROUGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 MCGHEE DRIVE
BATON ROUGE LA
70815
US

IV. Provider business mailing address

8352 BLUEBONNET BLVD
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 225-284-7504
  • Fax: 225-272-0950
Mailing address:
  • Phone: 225-928-8989
  • Fax: 225-928-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number627011
License Number StateLA

VIII. Authorized Official

Name: MR. CHARLES LANPHIER
Title or Position: OWNER
Credential:
Phone: 225-928-8989