Healthcare Provider Details

I. General information

NPI: 1326298258
Provider Name (Legal Business Name): MCCORKLE SUNRISE PCA/SIL,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7262 POINSETTIA DR
BATON ROUGE LA
70812-1861
US

IV. Provider business mailing address

2036 WOODDALE BLVD SUITE M
BATON ROUGE LA
70806-1518
US

V. Phone/Fax

Practice location:
  • Phone: 225-288-6931
  • Fax: 225-935-2209
Mailing address:
  • Phone: 225-935-2208
  • Fax: 225-935-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ANN MCCORKLE
Title or Position: GENERAL MANAGER /OWNER
Credential:
Phone: 225-935-2208