Healthcare Provider Details

I. General information

NPI: 1326176629
Provider Name (Legal Business Name): MC2 ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 PERKINS RD
BATON ROUGE LA
70808-3040
US

IV. Provider business mailing address

4715 PERKINS RD
BATON ROUGE LA
70808-3040
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-0110
  • Fax: 225-923-0111
Mailing address:
  • Phone: 225-923-0110
  • Fax: 225-923-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateLA

VIII. Authorized Official

Name: GLORIA WALL
Title or Position: OWNER
Credential: P.T.
Phone: 225-923-0110