Healthcare Provider Details

I. General information

NPI: 1699101675
Provider Name (Legal Business Name): PEDIATRUST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 FLORIDA AVE SW
DENHAM SPRINGS LA
70726-4914
US

IV. Provider business mailing address

2041 FLORIDA BLVD SW
DENHAM SPRINGS LA
70726
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-7287
  • Fax:
Mailing address:
  • Phone: 225-665-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LEANN CRAIG
Title or Position: CEO
Credential:
Phone: 225-252-7633