Healthcare Provider Details

I. General information

NPI: 1447464961
Provider Name (Legal Business Name): MRS. PEARLIE B FLUGENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 VETERANS DR
CARENCRO LA
70520-3520
US

IV. Provider business mailing address

403 VETERANS DR
CARENCRO LA
70520-3520
US

V. Phone/Fax

Practice location:
  • Phone: 337-886-0108
  • Fax: 337-886-1413
Mailing address:
  • Phone: 337-886-0108
  • Fax: 337-886-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number4444
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: