Healthcare Provider Details

I. General information

NPI: 1508997313
Provider Name (Legal Business Name): PACER HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 W CREOLE HWY
CAMERON LA
70631-5127
US

IV. Provider business mailing address

5360 W CREOLE HWY
CAMERON LA
70631-5127
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-8111
  • Fax: 337-439-1970
Mailing address:
  • Phone: 337-439-8111
  • Fax: 337-439-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number534
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number534
License Number StateLA

VIII. Authorized Official

Name: MS. DONNA N MEAD
Title or Position: CEO
Credential:
Phone: 337-439-8111