Healthcare Provider Details

I. General information

NPI: 1699088567
Provider Name (Legal Business Name): CARE TEC PEDIATRIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 SHIRLEY RD
BUNKIE LA
71322-1540
US

IV. Provider business mailing address

855 SHIRLEY RD
BUNKIE LA
71322-1540
US

V. Phone/Fax

Practice location:
  • Phone: 318-346-7337
  • Fax: 318-346-2339
Mailing address:
  • Phone: 318-346-7337
  • Fax: 337-346-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number981
License Number StateLA

VIII. Authorized Official

Name: ELIZABETH A LAMBETH
Title or Position: OWNER/ADMINISTRATOR
Credential: RN, BSN
Phone: 337-301-1029